Provider Demographics
NPI:1033691043
Name:EYE SPECIALISTS OF NEW YORK, PC
Entity Type:Organization
Organization Name:EYE SPECIALISTS OF NEW YORK, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-624-4474
Mailing Address - Street 1:10005 ROOSEVELT AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-4880
Mailing Address - Country:US
Mailing Address - Phone:917-832-7557
Mailing Address - Fax:917-832-7503
Practice Address - Street 1:10005 ROOSEVELT AVE STE 202
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-4880
Practice Address - Country:US
Practice Address - Phone:917-832-7557
Practice Address - Fax:917-832-7503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY266984207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma SpecialistGroup - Single Specialty