Provider Demographics
NPI:1417239500
Name:NORTH SHORE HAMPTON MEDICAL AND SURGICAL EYE CARE, P.C.
Entity Type:Organization
Organization Name:NORTH SHORE HAMPTON MEDICAL AND SURGICAL EYE CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-265-8780
Mailing Address - Street 1:260 MIDDLE COUNTRY RD
Mailing Address - Street 2:201
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2982
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:54 COMMERCE AVE
Practice Address - Street 2:SUITE 6 RIVERHEAD COMMERCE PARK
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-4454
Practice Address - Country:US
Practice Address - Phone:631-265-8780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty