Provider Demographics
NPI:1437697380
Name:SIGHT SAVER MONMOUTH
Entity type:Organization
Organization Name:SIGHT SAVER MONMOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIDEL
Authorized Official - Suffix:III
Authorized Official - Credentials:OD
Authorized Official - Phone:732-505-4444
Mailing Address - Street 1:600 UNION AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BRIELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08730-1843
Mailing Address - Country:US
Mailing Address - Phone:732-223-4242
Mailing Address - Fax:
Practice Address - Street 1:600 UNION AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:BRIELLE
Practice Address - State:NJ
Practice Address - Zip Code:08730-1843
Practice Address - Country:US
Practice Address - Phone:732-223-4242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA5921152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ135192Medicare UPIN