Advanced Eye Professionals LLC
Organization Active NPI Optometrist · Manalapan, NJ
NPI 1497917520 · NPPES record last updated Nov 14, 2012
Key facts
- NPI
- 1497917520
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 270M00031600 (NJ)
- Legal business name
- ADVANCED EYE PROFESSIONALS LLC
- Practice address
- 225 Gordons Corner Rd
Suite 1C
Manalapan, NJ 07726-3356 - Phone
- (732) 792-9800
- NPI assigned
- Jun 30, 2008
- Organization subpart
- No
Authorized official
- Name
- Sergio Peneiras
- Title
- President
- Phone
- (732) 792-9800
Corporate family (same tax ID) 1
Practitioners 2
-
Sergio Peneiras, O.D.
-
Erica O'Lenick, OD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20121004000560 | NJ | Part B Supplier - Clinic/Group Practice | 8123277290 |
Receives reassigned benefits from 2 practitioners Practice locations: Long Branch, NJ; Manalapan, NJ |
National Provider Directory
- Tax ID family
- Advance Eye Professionals
Locations
112 Brighton Ave
Long Branch, NJ 07740
Phone (732) 870-1088
225 Gordons Corner Rd
Ste 1C
Manalapan, NJ 07726
Phone (732) 792-9800
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 270M00031600 | NJ | Yes |
Addresses
Primary practice location
225 Gordons Corner Rd
Suite 1C
Manalapan, NJ 07726-3356
Mailing address
225 Gordons Corner Rd
Suite 1C
Manalapan, NJ 07726-3356
Phone (732) 792-9800
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8358401 | Medicaid | NJ | |
| 039686 | Other | NJ | MEDICARE ID - TYPE UNSPECIFIED |
Other names
- Brighton Eye Care
Other providers in Manalapan, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 14, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.