Provider Demographics
NPI:1275781429
Name:EAGLE RIVER OPHTHALMIC SURGEONS LLC
Entity Type:Organization
Organization Name:EAGLE RIVER OPHTHALMIC SURGEONS LLC
Other - Org Name:ERICARECT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:C
Authorized Official - Last Name:TSANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-561-0774
Mailing Address - Street 1:84 TIMBERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-1466
Mailing Address - Country:US
Mailing Address - Phone:860-943-1997
Mailing Address - Fax:
Practice Address - Street 1:11 MOUNTAIN AVE
Practice Address - Street 2:STE 308
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2343
Practice Address - Country:US
Practice Address - Phone:860-943-1997
Practice Address - Fax:860-943-1990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-29
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No156FX1101XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1020508Medicaid