Eye Society Boutique LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

EYE SOCIETY BOUTIQUE LLC

Practice address

610 Cross Keys Rd Ste 203
Sicklerville, NJ 08081-9580

Phone

(856) 250-1515

Fax

(856) 245-5536

NPI assigned

Oct 18, 2022

Organization subpart

No

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

Authorized official

Name

Gaithri Ramanathan, O.D., F.A.A.ONPI 1023214160

Title

Optometrist

Phone

(856) 250-1515

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Practitioners 1

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

• Gaithri Ramanathan, O.D.

  • Optometrist
  • Sicklerville, NJ
  • NPI 1023214160
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1666051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666051200000",
    "number": "1124744438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 CROSS KEYS RD STE 203",
            "city": "SICKLERVILLE",
            "state": "NJ",
            "postal_code": "080819580",
            "telephone_number": "856-250-1515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 CROSS KEYS RD STE 203",
            "city": "SICKLERVILLE",
            "state": "NJ",
            "postal_code": "080819580",
            "telephone_number": "856-250-1515",
            "fax_number": "856-245-5536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE SOCIETY BOUTIQUE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-18",
        "last_updated": "2022-10-18",
        "certification_date": "2022-10-18",
        "status": "A",
        "authorized_official_last_name": "RAMANATHAN",
        "authorized_official_first_name": "GAITHRI",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "856-250-1515",
        "authorized_official_credential": "O.D., F.A.A.O"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Sicklerville, NJ
• Providers in Sicklerville, NJ by specialty
• Optometrist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2022; 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.