Provider Demographics
NPI:1053784462
Name:EDISON EYE ASSOCIATES
Entity type:Organization
Organization Name:EDISON EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUMHOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:732-494-8484
Mailing Address - Street 1:1655 OAK TREE RD STE 265
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2856
Mailing Address - Country:US
Mailing Address - Phone:732-494-8484
Mailing Address - Fax:732-494-8487
Practice Address - Street 1:1655 OAK TREE RD STE 265
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2856
Practice Address - Country:US
Practice Address - Phone:732-494-8484
Practice Address - Fax:732-494-8487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier