Provider Demographics
NPI:1326107251
Name:NORTH COUNTRY OPHTHALMOLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:NORTH COUNTRY OPHTHALMOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENYS
Authorized Official - Middle Name:A
Authorized Official - Last Name:BEAUVAIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-393-0392
Mailing Address - Street 1:3 LYON PLACE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OGDESNBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-2590
Mailing Address - Country:US
Mailing Address - Phone:315-393-0392
Mailing Address - Fax:315-393-0591
Practice Address - Street 1:3 LYON PLACE
Practice Address - Street 2:SUITE 101
Practice Address - City:OGDESNBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-2590
Practice Address - Country:US
Practice Address - Phone:315-393-0392
Practice Address - Fax:315-393-0591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01243407Medicaid
NY01237012Medicaid
NY01237012Medicaid
AA0390Medicare PIN
NY01243407Medicaid