Provider Demographics
NPI:1306863097
Name:MEDICAL SURGICAL EYE CARE SERVICES PC
Entity Type:Organization
Organization Name:MEDICAL SURGICAL EYE CARE SERVICES PC
Other - Org Name:THE CENTER FOR EYE CARE AND OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:M
Authorized Official - Last Name:ATTENIESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-422-1110
Mailing Address - Street 1:360 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4403
Mailing Address - Country:US
Mailing Address - Phone:631-422-1110
Mailing Address - Fax:631-422-1916
Practice Address - Street 1:360 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795
Practice Address - Country:US
Practice Address - Phone:631-422-1110
Practice Address - Fax:631-422-1916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02245045Medicaid
NYW20001Medicare PIN