Provider Demographics
NPI:1962525584
Name:EYE INSTITUTE OF SOUTH JERSEY, P.C.
Entity type:Organization
Organization Name:EYE INSTITUTE OF SOUTH JERSEY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FAWN
Authorized Official - Middle Name:C
Authorized Official - Last Name:PERNELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-205-1100
Mailing Address - Street 1:3071 E CHESTNUT AVE
Mailing Address - Street 2:SUITE B 6
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-7847
Mailing Address - Country:US
Mailing Address - Phone:856-205-1100
Mailing Address - Fax:856-205-1100
Practice Address - Street 1:3071 E CHESTNUT AVE
Practice Address - Street 2:SUITE B 6
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361-7847
Practice Address - Country:US
Practice Address - Phone:856-205-1100
Practice Address - Fax:856-205-1100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00581400152W00000X
NJMA56275207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Not Answered207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE84898Medicare UPIN