Provider Demographics
NPI:1588299762
Name:EDGEWATER EYECARE INC
Entity type:Organization
Organization Name:EDGEWATER EYECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:248-703-0367
Mailing Address - Street 1:291 ROSLYN CT
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-8323
Mailing Address - Country:US
Mailing Address - Phone:248-703-0367
Mailing Address - Fax:
Practice Address - Street 1:75 RIVER RD STE 210
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1075
Practice Address - Country:US
Practice Address - Phone:201-340-6406
Practice Address - Fax:201-340-6407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-08
Last Update Date:2020-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty