Provider Demographics
NPI:1538431531
Name:SEE SHORE EYE ASSOCIATES PC
Entity type:Organization
Organization Name:SEE SHORE EYE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOGDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-846-4836
Mailing Address - Street 1:201 TILTON RD
Mailing Address - Street 2:SUITE 16
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1247
Mailing Address - Country:US
Mailing Address - Phone:609-846-4836
Mailing Address - Fax:609-641-3990
Practice Address - Street 1:201 TILTON RD
Practice Address - Street 2:SUITE 16
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1247
Practice Address - Country:US
Practice Address - Phone:609-846-4836
Practice Address - Fax:609-641-3990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08680600207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ234105Medicare PIN