Provider Demographics
NPI:1508952540
Name:CORTLAND OPHTHALMOLOGICAL CARE, PLLC
Entity Type:Organization
Organization Name:CORTLAND OPHTHALMOLOGICAL CARE, PLLC
Other - Org Name:CORTLAND EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-753-7528
Mailing Address - Street 1:1160 TOMPKINS ST
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-3578
Mailing Address - Country:US
Mailing Address - Phone:607-753-7528
Mailing Address - Fax:607-756-8163
Practice Address - Street 1:1160 TOMPKINS ST
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-3578
Practice Address - Country:US
Practice Address - Phone:607-753-7528
Practice Address - Fax:607-756-8163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005836152W00000X
NY006144156FX1800X
NY226008207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5768320001Medicare NSC