Organization Active NPI

Bedminster Eye and Laser Center, P.a.

  • Ophthalmology Physician
  • Bedminster, NJ
National Provider Identifier
1659473973
Registry record updated Jul 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
25MA04973100 Issued in NJ
Legal business name
BEDMINSTER EYE AND LASER CENTER, P.A.
Practice address
400 Main St.
Bedminster, NJ 07921
Phone
(908) 781-2020
NPI assigned
Sep 5, 2006
Last updated
Jul 1, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2008

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

Authorized official

Name
Ms. Lori McCann
Title
Practice Consultant
Phone
(908) 781-2020

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OA05514 NJ
Ophthalmology Physician 207W00000X 25MA04973100 NJ Primary

Addresses

Primary practice location

400 Main St.
Bedminster, NJ 07921

Mailing address

PO Box 103
Bedminster, NJ 07921-0103
Phone (908) 781-2020

Other identifiers 4

IdentifierTypeStateIssuer
1170601MedicaidNJ
27207OtherNJAETNA
OM1314OtherNJHEALTNET
TS113OtherNJOXFORD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050314000772 NJ Part B Supplier - Clinic/Group Practice 8628023538 Receives reassigned benefits from 6 practitioners
Practice locations: Bedminster, NJ; Teaneck, NJ

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
31D2141978Bedminster Eye & Laser Center400 Main Street, Bedminster, NJ 07921Certificate of waiverDec 27, 2027

National Provider Directory

National Provider Directory

Locations

400 Main St
#2
Bedminster, NJ 07921

773 Teaneck Rd
Ste B
Teaneck, NJ 07666

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1157414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214870400000",
    "number": "1659473973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 103",
            "city": "BEDMINSTER",
            "state": "NJ",
            "postal_code": "079210103",
            "telephone_number": "908-781-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 MAIN ST.",
            "city": "BEDMINSTER",
            "state": "NJ",
            "postal_code": "07921",
            "telephone_number": "908-781-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEDMINSTER EYE AND LASER CENTER, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-05",
        "last_updated": "2008-07-01",
        "status": "A",
        "authorized_official_last_name": "MCCANN",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "PRACTICE CONSULTANT",
        "authorized_official_telephone_number": "908-781-2020",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NJ",
            "license": "OA05514",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NJ",
            "license": "25MA04973100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1170601",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "27207",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTNET",
            "identifier": "OM1314",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "TS113",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bedminster, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.