1881725810 NPI number — EYE SURGEONS OF CENTRAL NEW YORK, PC

Table of content: (NPI 1881725810)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881725810 NPI number — EYE SURGEONS OF CENTRAL NEW YORK, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYE SURGEONS OF CENTRAL NEW YORK, 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:
1881725810
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5100 W. TAFT ROAD, SUITE 4M
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIVERPOOL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13088
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-362-3937
Provider Business Mailing Address Fax Number:
315-458-7818

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5100 W TAFT RD STE 4M
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIVERPOOL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13088-3810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-362-3937
Provider Business Practice Location Address Fax Number:
315-458-7818
Provider Enumeration Date:
03/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VANALLEN
Authorized Official First Name:
CHIP
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
FINANCIAL MANAGER
Authorized Official Telephone Number:
315-382-4284

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  TUV005797-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 154663-1 , 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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