1407829856 NPI number — SUNY COLLEGE OF OPTOMETRY

Table of content: (NPI 1407829856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407829856 NPI number — SUNY COLLEGE OF OPTOMETRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNY COLLEGE OF OPTOMETRY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
UNIVERSITY EYE CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407829856
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33 WEST 42ND STREET
Provider Second Line Business Mailing Address:
CLINICAL ADMINISTRATION
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10036-8005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-938-5831
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33 WEST 42ND STREET
Provider Second Line Business Practice Location Address:
CLINICAL ADMINISTRATION
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10036-8005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-938-4030
Provider Business Practice Location Address Fax Number:
212-938-5858
Provider Enumeration Date:
02/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCGOVERN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF MEDICAL OFFICE
Authorized Official Telephone Number:
212-938-5946

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00244528 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: CI7179 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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