Provider Demographics
NPI:1982751939
Name:MANAHAWKIN VISION INC.
Entity type:Organization
Organization Name:MANAHAWKIN VISION INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGLAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-597-0250
Mailing Address - Street 1:733 ROUTE 72 W
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2839
Mailing Address - Country:US
Mailing Address - Phone:609-597-0250
Mailing Address - Fax:609-597-0252
Practice Address - Street 1:733 ROUTE 72 W
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2839
Practice Address - Country:US
Practice Address - Phone:609-597-0250
Practice Address - Fax:609-597-0252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00427900152W00000X
NJ27OA00426400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJK16299OtherDR. SHISSIAS HEALTHNET ID
NJ2533201Medicaid
NJ6952208Medicaid
NJNJ4264OtherEYEMED GROUP NUMBER
NJ4501820OtherDR. MELTZER AETNA ID
NJNJ04264OtherVBA GROUP NUMBER
NJEYEF01296OtherSPECTERA GROUP NUMBER
NJ085288Medicare ID - Type UnspecifiedOFFICE GROUP NUMBER
NJ503805AK2Medicare ID - Type UnspecifiedDEAN SHISSIAS OD
NJ085288Medicare PIN
NJEYEF01296OtherSPECTERA GROUP NUMBER
NJ6952208Medicaid
NJNJ04264OtherVBA GROUP NUMBER
NJ4501820OtherDR. MELTZER AETNA ID
NJ1117780001Medicare NSC