Complete Family Eye Care Optometry PA

Primary specialty

OptometristTaxonomy code 152W00000X

License

27OA00577200 Issued in NJ

Legal business name

COMPLETE FAMILY EYE CARE OPTOMETRY PA

Practice address

400 Commons Way
Suite 354
Bridgewater, NJ 08807-3294

Phone

(908) 725-0008

Fax

(908) 725-0078

NPI assigned

Mar 3, 2014

Organization subpart

No

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

Authorized official

Name

Mr. Oleg Lisitsyn, OD

Title

Owner

Phone

(908) 725-0008

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1393804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548288000000",
    "number": "1770908576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 COMMONS WAY",
            "address_2": "SUITE 354",
            "city": "BRIDGEWATER",
            "state": "NJ",
            "postal_code": "088073294",
            "telephone_number": "908-725-0008",
            "fax_number": "908-725-0078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 COMMONS WAY",
            "address_2": "SUITE 354",
            "city": "BRIDGEWATER",
            "state": "NJ",
            "postal_code": "088073294",
            "telephone_number": "908-725-0008",
            "fax_number": "908-725-0078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPLETE FAMILY EYE CARE OPTOMETRY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-03",
        "last_updated": "2019-01-24",
        "status": "A",
        "authorized_official_last_name": "LISITSYN",
        "authorized_official_first_name": "OLEG",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "908-725-0008",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NJ",
            "license": "27OA00577200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HORIZON BCBS",
            "identifier": "60098307",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0406783",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.