Provider Demographics
NPI:1518956515
Name:EYE CARE FOR THE ADIRONDACKS ASSOCIATES IN OPHTHALMOLOGY PC
Entity Type:Organization
Organization Name:EYE CARE FOR THE ADIRONDACKS ASSOCIATES IN OPHTHALMOLOGY PC
Other - Org Name:KJELL DAHLEN MD PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KJELL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAHLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-566-2020
Mailing Address - Street 1:450 MARGARET ST
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-1755
Mailing Address - Country:US
Mailing Address - Phone:518-566-2020
Mailing Address - Fax:518-561-5390
Practice Address - Street 1:450 MARGARET ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1755
Practice Address - Country:US
Practice Address - Phone:518-566-2020
Practice Address - Fax:518-561-5390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-21
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01538352Medicaid
NY107286OtherEXCELLUS
NYW6N441OtherEMPIRE BLUE CROSS
NY107286OtherEXCELLUS
NY01538352Medicaid