Provider Demographics
NPI: | 1417750191 |
---|---|
Name: | AURORA EYECARE LLC |
Entity type: | Organization |
Organization Name: | AURORA EYECARE LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OPTOMETRIST |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | TALIA |
Authorized Official - Middle Name: | M |
Authorized Official - Last Name: | MISHKIN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | OD |
Authorized Official - Phone: | 732-492-7922 |
Mailing Address - Street 1: | 600 E MAIN ST |
Mailing Address - Street 2: | |
Mailing Address - City: | BRIDGEWATER |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 08807-3231 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 600 E MAIN ST |
Practice Address - Street 2: | |
Practice Address - City: | BRIDGEWATER |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 08807-3231 |
Practice Address - Country: | US |
Practice Address - Phone: | 732-492-7922 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2025-03-28 |
Last Update Date: | 2025-03-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 152W00000X | Eye and Vision Services Providers | Optometrist | Group - Multi-Specialty | |
No | 152WC0802X | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management | Group - Multi-Specialty |