1811397433 NPI number — EYE PHYSICIANS OF ORANGE COUNTY, PC

Table of content: (NPI 1811397433)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811397433 NPI number — EYE PHYSICIANS OF ORANGE COUNTY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYE PHYSICIANS OF ORANGE COUNTY, PC
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:
Provider Other Organization Name Type Code:
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:
1811397433
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 HATFIELD LANE
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
GOSHEN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10924-6753
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-294-5128
Provider Business Mailing Address Fax Number:
845-294-1479

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32 CANAL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT JERVIS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12771-1638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-672-3960
Provider Business Practice Location Address Fax Number:
845-672-3157
Provider Enumeration Date:
09/02/2014

Additional Information

Authorized Official

Authorized Official Last Name:
GREEN
Authorized Official First Name:
LESLIE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
845-294-5128

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 149367 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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