Provider Demographics
NPI:1366595241
Name:YOUR EYES INC.
Entity type:Organization
Organization Name:YOUR EYES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:
Authorized Official - Last Name:DIBARTOLO
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:856-234-9060
Mailing Address - Street 1:135 QUAKERBRIDGE MALL
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-1902
Mailing Address - Country:US
Mailing Address - Phone:609-799-8380
Mailing Address - Fax:609-799-5707
Practice Address - Street 1:135 QUAKERBRIDGE MALL
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-1902
Practice Address - Country:US
Practice Address - Phone:609-799-8380
Practice Address - Fax:609-799-5707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00078800332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3082806Medicaid
NJ0548730001OtherMEDICARE-DME
NJ3082806Medicaid