Provider Demographics
NPI:1144351560
Name:HIGH MOUNTAIN EYECARE, LLC
Entity type:Organization
Organization Name:HIGH MOUNTAIN EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:973-427-7801
Mailing Address - Street 1:33 SICOMAC RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NORTH HALEDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-2971
Mailing Address - Country:US
Mailing Address - Phone:973-427-7801
Mailing Address - Fax:973-427-7969
Practice Address - Street 1:33 SICOMAC RD
Practice Address - Street 2:SUITE 204
Practice Address - City:NORTH HALEDON
Practice Address - State:NJ
Practice Address - Zip Code:07508-2971
Practice Address - Country:US
Practice Address - Phone:973-427-7801
Practice Address - Fax:973-427-7969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA5324152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ035782Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
NJU55002Medicare UPIN
NJ1310500001Medicare NSC