Provider Demographics
NPI:1043743222
Name:EYE CONSULTANTS OF SYRACUSE PC
Entity Type:Organization
Organization Name:EYE CONSULTANTS OF SYRACUSE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED SIGNATORY
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPITZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-422-4412
Mailing Address - Street 1:5792 WIDEWATERS PKWY
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13214-1847
Mailing Address - Country:US
Mailing Address - Phone:315-422-4412
Mailing Address - Fax:315-422-4690
Practice Address - Street 1:15 BRONSON ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-1004
Practice Address - Country:US
Practice Address - Phone:315-342-6176
Practice Address - Fax:315-342-3120
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE CONSULTANTS OF SYRACUSE PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty