Evesham Eye Associates, Inc.
Organization Active NPI Optometrist · Marlton, NJ
NPI 1619987062 · NPPES record last updated Apr 21, 2021
Key facts
- NPI
- 1619987062
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 27OA00598300 (NJ)
- Legal business name
- EVESHAM EYE ASSOCIATES, INC.
- Practice address
- 151 W Greentree Rd
Suite B
Marlton, NJ 08053-9416 - Phone
- (856) 985-0066
- Fax
- (856) 985-8104
- NPI assigned
- Aug 8, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Albert J Staab, OD
- Title
- Owner
- Phone
- (856) 985-0066
Practitioners 4
-
Albert J Staab, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190409002337 | NJ | Part B Supplier - Clinic/Group Practice | 7719983220 |
Receives reassigned benefits from 2 practitioners Practice locations: Marlton, NJ |
National Provider Directory
Locations
151 Greentree Rd
Ste B
Marlton, NJ 08053
Phone (856) 702-6700
65 Route 70 E
Ste 3
Marlton, NJ 08053
Phone (856) 596-4416
65 Route 70 E
Ste B
Marlton, NJ 08053
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 27OA00598300 | NJ | Yes |
Addresses
Primary practice location
151 W Greentree Rd
Suite B
Marlton, NJ 08053-9416
Mailing address
65 Route 70 E Ste B
Marlton, NJ 08053-1747
Phone (856) 985-0066
Other practice location 1
65 Route 70 E Ste 3
Marlton, NJ 08053-1747
Phone (856) 596-4416
Other names
- Marlton Eye Associates
Other providers in Marlton, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 21, 2021. 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.