Provider Demographics
NPI:1992260814
Name:ELEMENTAL EYECARE LLC
Entity type:Organization
Organization Name:ELEMENTAL EYECARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEI
Authorized Official - Middle Name:WEN
Authorized Official - Last Name:MOY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-299-5907
Mailing Address - Street 1:54 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07660-1427
Mailing Address - Country:US
Mailing Address - Phone:512-299-5907
Mailing Address - Fax:
Practice Address - Street 1:21 GOLDSBOROUGH DR
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-5069
Practice Address - Country:US
Practice Address - Phone:201-354-2350
Practice Address - Fax:551-800-7778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-05
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty