Basic Information
| Provider Information | |||||||||
| NPI: | 1780772046 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OUTLOOK EYECARE, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 CENTRE DR | ||||||||
| Address2: | SUITE 1B | ||||||||
| City: | MONROE TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088311564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094092778 | ||||||||
| FaxNumber: | 6094092718 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 CENTRE DR | ||||||||
| Address2: | SUITE 1B | ||||||||
| City: | MONROE TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088311564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094092778 | ||||||||
| FaxNumber: | 6094092718 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 09/10/2008 | ||||||||
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| AuthorizedOfficialLastName: | GRABOWSKI | ||||||||
| AuthorizedOfficialFirstName: | WAYNE | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | PRES. | ||||||||
| AuthorizedOfficialTelephone: | 6094092778 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 25MA03961900 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | CK3685 | 01 | NJ | RAILROAD MEDICARE | OTHER |