Provider Demographics
NPI:1336325158
Name:HORNELL EYE ASSOCIATES LLC
Entity Type:Organization
Organization Name:HORNELL EYE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FORSHEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-324-4822
Mailing Address - Street 1:34 BROADWAY MALL
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-1920
Mailing Address - Country:US
Mailing Address - Phone:607-324-4822
Mailing Address - Fax:
Practice Address - Street 1:34 BROADWAY MALL
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1920
Practice Address - Country:US
Practice Address - Phone:607-324-4822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004055152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00465816Medicaid
NY00879314Medicaid
NY01624708Medicaid
NYBA1330Medicare PIN
NYH85072Medicare UPIN
NYU67583Medicare UPIN
NY01624708Medicaid
NY00879314Medicaid
NY00465816Medicaid
NYB72455Medicare UPIN
NY0997920001Medicare NSC