Provider Demographics
NPI:1265667380
Name:ELLICOTTVILLE EYE CARE, PC
Entity Type:Organization
Organization Name:ELLICOTTVILLE EYE CARE, PC
Other - Org Name:PHILIP A. SSARIKEY, OD, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OD
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:SARIKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-699-5293
Mailing Address - Street 1:2 HUGHEY ALY
Mailing Address - Street 2:PO BOX 1340
Mailing Address - City:ELLICOTTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14731
Mailing Address - Country:US
Mailing Address - Phone:716-699-5293
Mailing Address - Fax:
Practice Address - Street 1:2 HUGHEY ALY
Practice Address - Street 2:
Practice Address - City:ELLICOTTVILLE
Practice Address - State:NY
Practice Address - Zip Code:14731-7002
Practice Address - Country:US
Practice Address - Phone:716-699-5293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005139152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY285183Medicare PIN
NYJ100000205Medicare PIN
NYU20783Medicare UPIN