Organization
WISE FAMILY EYE CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD BRYAN WISE M.D. (OWNER)
(609) 652-1010
Entity
Organization
Contact information
Practice address
54 W JIMMIE LEEDS RD UNIT 15, GALLOWAY, NJ 08205-9401
(609) 652-1010
Mailing address
54 W JIMMIE LEEDS RD UNIT 15, GALLOWAY, NJ 08205-9401
(609) 652-1010
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
MA72455
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2398350000
AMERIHEALTH
—
01
—
3840133
AETNA HMO
NJ
01
—
60000622
HORIZON MERCY
NJ
05
—
8640408
—
NJ
Enumeration date
06/04/2007
Last updated
01/03/2008
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