Provider Demographics
NPI:1073530952
Name:GLAUCOMA CONSULTANTS OF THE CAPITAL REGION,PLLC
Entity Type:Organization
Organization Name:GLAUCOMA CONSULTANTS OF THE CAPITAL REGION,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:TROTTER
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-475-7300
Mailing Address - Street 1:PO BOX 115
Mailing Address - Street 2:
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-0115
Mailing Address - Country:US
Mailing Address - Phone:518-475-7300
Mailing Address - Fax:518-475-9174
Practice Address - Street 1:1240 NEW SCOTLAND RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SLINGERLANDS
Practice Address - State:NY
Practice Address - Zip Code:12159-9222
Practice Address - Country:US
Practice Address - Phone:518-475-7300
Practice Address - Fax:518-475-9174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCG7910OtherRAILROAD MEDICARE
NYCG7910OtherRAILROAD MEDICARE
NYAA0425Medicare PIN