1245327550 NPI number — ROCHESTER EYE CARE GROUP, PC

Table of content: (NPI 1245327550)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245327550 NPI number — ROCHESTER EYE CARE GROUP, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROCHESTER EYE CARE GROUP, 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:
6
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:
1245327550
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 N UNION ST
Provider Second Line Business Mailing Address:
101
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14607-1345
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-232-2560
Provider Business Mailing Address Fax Number:
585-232-6446

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 N UNION ST
Provider Second Line Business Practice Location Address:
101
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14607-1345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-232-2560
Provider Business Practice Location Address Fax Number:
585-232-6446
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BALDICK
Authorized Official First Name:
JEFFERY
Authorized Official Middle Name:
E
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
585-546-7610

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01750756 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: G0189600590 . This is a "EXCELLUS BLUE CHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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