Provider Demographics
NPI:1124012737
Name:RETINA-VITREOUS SURGEONS OF CENTRAL NEW YORK, PC
Entity Type:Organization
Organization Name:RETINA-VITREOUS SURGEONS OF CENTRAL NEW YORK, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS SERVICES COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-445-8166
Mailing Address - Street 1:200 GREENFIELD PKWY
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-6655
Mailing Address - Country:US
Mailing Address - Phone:315-445-8166
Mailing Address - Fax:315-445-2697
Practice Address - Street 1:200 GREENFIELD PKWY
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-6655
Practice Address - Country:US
Practice Address - Phone:315-445-8166
Practice Address - Fax:315-445-2697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY34615AMedicare ID - Type Unspecified