Provider Demographics
NPI:1114148442
Name:ADIRONDACK EYE PHYSICIANS & SURGEONS PC
Entity Type:Organization
Organization Name:ADIRONDACK EYE PHYSICIANS & SURGEONS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOPPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-792-1300
Mailing Address - Street 1:152 BAY ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-2329
Mailing Address - Country:US
Mailing Address - Phone:518-792-1300
Mailing Address - Fax:518-792-3030
Practice Address - Street 1:152 BAY ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-2329
Practice Address - Country:US
Practice Address - Phone:518-792-1300
Practice Address - Fax:518-792-3030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY38662AMedicare PIN