Provision Family Eye Care

Primary specialty

OptometristTaxonomy code 152W00000X

License

27OA00611200 Issued in NJ

Legal business name

PROVISION FAMILY EYE CARE

Practice address

3452 Broidy Rd
McGuire Afb
Trenton, NJ 08641-5305

Phone

(609) 723-8957

NPI assigned

Mar 15, 2017

Organization subpart

No

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

Authorized official

Name

Monika Wysoczanska, ODNPI 1376737924

Title

Owner

Phone

(609) 723-8957

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.

• Monika Wysoczanska, OD

  • Optometrist
  • Manalapan, NJ
  • NPI 1376737924
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1489536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489536000000",
    "number": "1407397011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3452 BROIDY RD",
            "address_2": "MCGUIRE AFB",
            "city": "TRENTON",
            "state": "NJ",
            "postal_code": "086415305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3452 BROIDY RD",
            "address_2": "MCGUIRE AFB",
            "city": "TRENTON",
            "state": "NJ",
            "postal_code": "086415305",
            "telephone_number": "609-723-8957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVISION FAMILY EYE CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-15",
        "last_updated": "2017-03-15",
        "status": "A",
        "authorized_official_last_name": "WYSOCZANSKA",
        "authorized_official_first_name": "MONIKA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "609-723-8957",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NJ",
            "license": "27OA00611200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 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.