Provider Demographics
NPI:1114146073
Name:MID ISLAND EYE PHYSICIANS & SURGEONS PC
Entity Type:Organization
Organization Name:MID ISLAND EYE PHYSICIANS & SURGEONS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER 26 PERCENT
Authorized Official - Prefix:
Authorized Official - First Name:TED
Authorized Official - Middle Name:A
Authorized Official - Last Name:KARL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-796-4030
Mailing Address - Street 1:4277 HEMPSTEAD TPKE
Mailing Address - Street 2:#109
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714
Mailing Address - Country:US
Mailing Address - Phone:516-796-4030
Mailing Address - Fax:516-796-5134
Practice Address - Street 1:4277 HEMPSTEAD TPKE
Practice Address - Street 2:#109
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714
Practice Address - Country:US
Practice Address - Phone:516-796-4030
Practice Address - Fax:516-796-5134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138520207W00000X
NY146480207W00000X
NY224064207W00000X
NY183193207W00000X
NY178691207W00000X
NY191081207W00000X
207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1073120001Medicare NSC
NYWCK121Medicare PIN