Provider Demographics
NPI:1346543147
Name:ZIEKER EYE OPHTHALMOLOGY, P.C.
Entity Type:Organization
Organization Name:ZIEKER EYE OPHTHALMOLOGY, P.C.
Other - Org Name:ZIEKER EYE OPHTHALMOLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:R
Authorized Official - Last Name:ZIEKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-450-1080
Mailing Address - Street 1:14 MOUNTAIN LEDGE DR.
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:NY
Mailing Address - Zip Code:12831-1858
Mailing Address - Country:US
Mailing Address - Phone:518-450-1080
Mailing Address - Fax:518-478-8500
Practice Address - Street 1:14 MOUNTAIN LEDGE
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:NY
Practice Address - Zip Code:12831-1858
Practice Address - Country:US
Practice Address - Phone:518-450-1080
Practice Address - Fax:518-478-8500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-16
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237533261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY25694475Medicaid
NY25694475Medicaid
NYRA9424Medicare PIN