Provider Demographics
NPI:1366550600
Name:MILLSBORO EYE CARE LLC
Entity type:Organization
Organization Name:MILLSBORO EYE CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:JAOUDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-684-2020
Mailing Address - Street 1:PO BOX 58
Mailing Address - Street 2:
Mailing Address - City:NASSAU
Mailing Address - State:DE
Mailing Address - Zip Code:19969-0058
Mailing Address - Country:US
Mailing Address - Phone:302-684-2020
Mailing Address - Fax:302-684-2021
Practice Address - Street 1:28322 LEWES GEORGETOWN HWY
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:DE
Practice Address - Zip Code:19968-3115
Practice Address - Country:US
Practice Address - Phone:302-684-2020
Practice Address - Fax:302-684-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000622562Medicaid
G99675Medicare UPIN
G01170Medicare ID - Type Unspecified
DE5699590001Medicare NSC