Provider Demographics
NPI:1487811949
Name:SOCIETY INC.
Entity type:Organization
Organization Name:SOCIETY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MERYL
Authorized Official - Middle Name:JILL
Authorized Official - Last Name:JISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-391-2011
Mailing Address - Street 1:20A CHESTNUT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1802
Mailing Address - Country:US
Mailing Address - Phone:201-391-2011
Mailing Address - Fax:
Practice Address - Street 1:20A CHESTNUT RIDGE RD
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-1802
Practice Address - Country:US
Practice Address - Phone:201-391-2011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0538940001Medicare NSC
NJLI564590Medicare PIN
T88174Medicare UPIN