Provider Demographics
NPI:1164617254
Name:EYE CARE MEDICINE SURGERY PC
Entity Type:Organization
Organization Name:EYE CARE MEDICINE SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PICANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-798-7449
Mailing Address - Street 1:46 ELM ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-3524
Mailing Address - Country:US
Mailing Address - Phone:518-793-9820
Mailing Address - Fax:518-793-7517
Practice Address - Street 1:357 BAY RD STE 7
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-3051
Practice Address - Country:US
Practice Address - Phone:518-798-7449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY56866AMedicare PIN