Provider Demographics
NPI:1477589901
Name:CAPITAL EYE CARE PHYSICIANS AND SURGEONS, PLLC
Entity Type:Organization
Organization Name:CAPITAL EYE CARE PHYSICIANS AND SURGEONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:G
Authorized Official - Last Name:KAMATH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-274-0657
Mailing Address - Street 1:2200 BURDETT AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-2451
Mailing Address - Country:US
Mailing Address - Phone:518-274-0657
Mailing Address - Fax:518-274-4224
Practice Address - Street 1:2200 BURDETT AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2451
Practice Address - Country:US
Practice Address - Phone:518-274-0657
Practice Address - Fax:518-274-4224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194839207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0855Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
NYAA0739Medicare PIN