Provider Demographics
NPI:1699902692
Name:ADVANCED EYE CARE CENTER
Entity type:Organization
Organization Name:ADVANCED EYE CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:SCOT
Authorized Official - Last Name:REING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-790-0179
Mailing Address - Street 1:220 HAMBURG TPKE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2110
Mailing Address - Country:US
Mailing Address - Phone:973-790-0179
Mailing Address - Fax:973-790-5310
Practice Address - Street 1:220 HAMBURG TPKE
Practice Address - Street 2:SUITE 7
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2110
Practice Address - Country:US
Practice Address - Phone:973-790-0179
Practice Address - Fax:973-790-5310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMAO62330332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1138620001OtherDURABLE MEDICAL GOODS IDENTIFICATION NUMBER