Provider Demographics
NPI:1174657175
Name:SUFFOLK EYE ASSOCIATES PC
Entity Type:Organization
Organization Name:SUFFOLK EYE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESDIENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAJKO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:757-925-1136
Mailing Address - Street 1:2463 PRUDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434
Mailing Address - Country:US
Mailing Address - Phone:757-925-1136
Mailing Address - Fax:757-925-0353
Practice Address - Street 1:2463 PRUDEN BLVD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434
Practice Address - Country:US
Practice Address - Phone:757-925-1136
Practice Address - Fax:757-925-0353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102036877174400000X, 207W00000X
VA0101054964174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6307108Medicaid
VA6301738Medicaid
VA6307108Medicaid
G26320Medicare UPIN