Organization
WISDA EYE CENTER PC
Active
Organization
WISDA EYE CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOANNE LOGAN (ADMINISTRATOR)
(856) 692-8008
Entity
Organization
Contact information
Practice address
1318 S MAIN RD, BLDG. 2A, VINELAND, NJ 08360-6516
(856) 692-8008
(856) 692-8044
Mailing address
1318 S MAIN RD, BLDG. 2A, VINELAND, NJ 08360-6516
(856) 692-8008
(856) 692-8044
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
25MA05025100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7014007
—
NJ
Enumeration date
06/22/2006
Last updated
08/23/2010
Update your record
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