Provider Demographics
NPI:1174930176
Name:OPTOMETRIC PHYSICIANS OF SEA GIRT, LLC.
Entity type:Organization
Organization Name:OPTOMETRIC PHYSICIANS OF SEA GIRT, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:GERSHENOW
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:732-530-6584
Mailing Address - Street 1:2204 HIGHWAY 35
Mailing Address - Street 2:SUITE 9
Mailing Address - City:SEA GIRT
Mailing Address - State:NJ
Mailing Address - Zip Code:08750-2323
Mailing Address - Country:US
Mailing Address - Phone:732-223-2800
Mailing Address - Fax:732-223-5121
Practice Address - Street 1:2204 HIGHWAY 35
Practice Address - Street 2:SUITE 9
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-2323
Practice Address - Country:US
Practice Address - Phone:732-223-2800
Practice Address - Fax:732-223-5121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty