Provider Demographics
NPI:1457331266
Name:EYE PHYSICIANS OF ORANGE COUNTY PC
Entity Type:Organization
Organization Name:EYE PHYSICIANS OF ORANGE COUNTY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:STAMM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-294-5128
Mailing Address - Street 1:1 HATFIELD LANE
Mailing Address - Street 2:STE 3 EYE PHYSICIANS OF ORANGE COUNTY PC
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924
Mailing Address - Country:US
Mailing Address - Phone:845-294-5128
Mailing Address - Fax:845-294-1479
Practice Address - Street 1:1 HATFIELD LANE
Practice Address - Street 2:STE 3 EYE PHYSICIANS OF ORANGE COUNTY PC
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924
Practice Address - Country:US
Practice Address - Phone:845-294-5128
Practice Address - Fax:845-294-1479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW11791Medicare ID - Type UnspecifiedGROUP NUMBER
0673850001Medicare NSC