NPIMap

Organization Active NPI

Bayshore Ophthalmology, LLC

  • Ophthalmology Physician
  • Tinton Falls, NJ
National Provider Identifier
1114101037
Registry record updated Apr 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
25MA07128400 Issued in NJ
Legal business name
BAYSHORE OPHTHALMOLOGY, LLC
Practice address
628 Shrewsbury Ave
Tinton Falls, NJ 07701-4932
Phone
(732) 842-2288
Fax
(732) 219-0072
NPI assigned
Dec 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Surekha Collur, MDNPI 1750491015
Title
Owner
Phone
(732) 264-6464

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X 27OA00562000 NJ
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X 25MA07128400 NJ Primary

Addresses

Primary practice location

628 Shrewsbury Ave
Tinton Falls, NJ 07701-4932

Mailing address

719 N Beers St
Suite 1B
Holmdel, NJ 07733-1522
Phone (732) 264-6464

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040419001224 NJ Part B Supplier - Clinic/Group Practice 1355336280 Receives reassigned benefits from 5 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Holmdel, NJ

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

719 N Beers St
Ste 1B
Holmdel, NJ 07733
Phone (732) 264-6464

721 N Beers St
Holmdel, NJ 07733
Phone (732) 264-6464

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1198713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207699200000",
    "number": "1114101037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "719 N BEERS ST",
            "address_2": "SUITE 1B",
            "city": "HOLMDEL",
            "state": "NJ",
            "postal_code": "077331522",
            "telephone_number": "732-264-6464",
            "fax_number": "732-264-5114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "628 SHREWSBURY AVE",
            "city": "TINTON FALLS",
            "state": "NJ",
            "postal_code": "077014932",
            "telephone_number": "732-842-2288",
            "fax_number": "732-219-0072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAYSHORE OPHTHALMOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-27",
        "last_updated": "2008-04-09",
        "status": "A",
        "authorized_official_last_name": "COLLUR",
        "authorized_official_first_name": "SUREKHA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "732-264-6464",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "NJ",
            "license": "27OA00562000",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "NJ",
            "license": "25MA07128400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tinton Falls, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.