Organization Active NPI

Garden State Eye Group, Inc.

  • Optometrist
  • Springfield, NJ
National Provider Identifier
1740606649
Registry record updated Jan 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
27OA00632500 Issued in NJ
Legal business name
GARDEN STATE EYE GROUP, INC.
Practice address
55 US Highway 22 E Ste D
Springfield, NJ 07081-3128
Phone
(973) 376-5555
NPI assigned
Mar 16, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2023

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

Authorized official

Name
Robert Vincent Digiacomo, ODNPI 1770857203
Title
Optometrist
Phone
(973) 376-5555

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 27OA00632500 NJ Primary

Addresses

Primary practice location

55 US Highway 22 E Ste D
Springfield, NJ 07081-3128

Mailing address

100 Route 46 W
Wayne, NJ 07470-6809

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140606001206 NJ Part B Supplier - Clinic/Group Practice 9436373768 Receives reassigned benefits from 5 practitioners
Practice locations: Springfield, NJ

National Provider Directory

National Provider Directory

Locations

55 Route 22
Springfield, NJ 07081
Phone (973) 376-5555

1508 Willowbrook Mall
Wayne, NJ 07470
Phone (973) 256-0060

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1394928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675123200000",
    "number": "1740606649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 ROUTE 46 W",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074706809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 US HIGHWAY 22 E STE D",
            "city": "SPRINGFIELD",
            "state": "NJ",
            "postal_code": "070813128",
            "telephone_number": "973-376-5555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARDEN STATE EYE GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-16",
        "last_updated": "2023-01-31",
        "certification_date": "2023-01-31",
        "status": "A",
        "authorized_official_last_name": "DIGIACOMO",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "VINCENT",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "973-376-5555",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NJ",
            "license": "27OA00632500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2023; 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.