Basic Information
| Provider Information | |||||||||
| NPI: | 1447385281 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE EYE-SITE | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 415 EGG HARBOR RD | ||||||||
| Address2: | SUITE 14 | ||||||||
| City: | SEWELL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080809211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8565892939 | ||||||||
| FaxNumber: | 8565895225 | ||||||||
| Practice Location | |||||||||
| Address1: | 415 EGG HARBOR RD | ||||||||
| Address2: | SUITE 14 | ||||||||
| City: | SEWELL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080809211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8565892939 | ||||||||
| FaxNumber: | 8565895225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2007 | ||||||||
| LastUpdateDate: | 12/11/2008 | ||||||||
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| AuthorizedOfficialLastName: | BONFIGLIO | ||||||||
| AuthorizedOfficialFirstName: | FREDERIC | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8565892939 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 31TD00070800 | NJ | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.