Fanwood Eye Care LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

27OA00643700 Issued in NJ

Legal business name

FANWOOD EYE CARE LLC

Practice address

246 South Ave
#106
Fanwood, NJ 07023-1220

Phone

(978) 987-0698

NPI assigned

Jan 12, 2017

Last updated

Nov 7, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kathy Shin, ODNPI 1457648867

Title

Owner

Phone

(908) 288-7227

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kathy Shin, O.D.

  • Optometrist
  • Fanwood, NJ
  • NPI 1457648867
  Medicare reassignment NPD Authorized official
• Sam Lee, O.D.

  • Optometrist
  • Hillsborough, NJ
  • NPI 1578932463
  Medicare reassignment NPD

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

{
    "created_epoch": "1484179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510012800000",
    "number": "1396281564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "246 SOUTH AVE",
            "address_2": "#106",
            "city": "FANWOOD",
            "state": "NJ",
            "postal_code": "070231220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "246 SOUTH AVE",
            "address_2": "#106",
            "city": "FANWOOD",
            "state": "NJ",
            "postal_code": "070231220",
            "telephone_number": "978-987-0698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FANWOOD EYE CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-12",
        "last_updated": "2017-11-07",
        "status": "A",
        "authorized_official_last_name": "SHIN",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "908-288-7227",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NJ",
            "license": "27OA00643700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daphna El-Roy, PH.D., BCBA-D
• Elderology, LLC
• English Chiropractic, LLC
• Eric Chludzinski, PC (Fanwood Back Relief Center)
• Fanwood Dental Associates, Inc.
• Fanwood Family and Cosmetic Dentistry
• Fanwood Family Dental
• Fanwood RX Corp (Fanwood Pharmacy LTC)
• Fanwood RX Corp (Fanwood Pharmacy)
• Fanwood Senior Care, LLC (The Chelsea at Fanwood)

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2017; 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.