Provider Demographics
NPI:1053391219
Name:DOUBLE VISION, PC
Entity type:Organization
Organization Name:DOUBLE VISION, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:LIPCHAK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:732-583-3600
Mailing Address - Street 1:443 RTE 34
Mailing Address - Street 2:SUITE F, MARKETPLACE MALL
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-9506
Mailing Address - Country:US
Mailing Address - Phone:732-583-3600
Mailing Address - Fax:732-583-3770
Practice Address - Street 1:443 RTE 34
Practice Address - Street 2:SUITE F, MARKETPLACE MALL
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-9506
Practice Address - Country:US
Practice Address - Phone:732-583-3600
Practice Address - Fax:732-583-3770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-21
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00505900152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1175140001Medicare NSC
NJU10215Medicare UPIN
132799Medicare PIN