Provider Demographics
NPI:1477623973
Name:EYE PHYSICIANS AND SURGEONS OF WESTERN NEW YORK PLLC
Entity Type:Organization
Organization Name:EYE PHYSICIANS AND SURGEONS OF WESTERN NEW YORK PLLC
Other - Org Name:OCUSIGHT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHARIF
Authorized Official - Middle Name:
Authorized Official - Last Name:EASSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-872-1300
Mailing Address - Street 1:2 GREECE CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14612
Mailing Address - Country:US
Mailing Address - Phone:585-225-7060
Mailing Address - Fax:585-872-7567
Practice Address - Street 1:2 GREECE CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612
Practice Address - Country:US
Practice Address - Phone:585-225-7060
Practice Address - Fax:585-872-7567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY14167AMedicare PIN