Provider Demographics
NPI:1063462133
Name:GEISS, MICHAEL J III (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:GEISS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2215 E GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2219
Mailing Address - Country:US
Mailing Address - Phone:315-472-5329
Mailing Address - Fax:315-472-3211
Practice Address - Street 1:2215 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2219
Practice Address - Country:US
Practice Address - Phone:315-472-5329
Practice Address - Fax:315-472-3211
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY186585207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01574143Medicaid
NY55536BMedicare PIN
NY01574143Medicaid