Provider Demographics
NPI:1568433142
Name:CENTRAL NEW YORK EYE CENTER, LTD
Entity Type:Organization
Organization Name:CENTRAL NEW YORK EYE CENTER, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GOVERNING BODY
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-471-3977
Mailing Address - Street 1:22 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1306
Mailing Address - Country:US
Mailing Address - Phone:845-471-3977
Mailing Address - Fax:845-471-9516
Practice Address - Street 1:22 GREEN ST
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1306
Practice Address - Country:US
Practice Address - Phone:845-471-3977
Practice Address - Fax:845-471-9516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1302209R261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01687296Medicaid
NYX17743Medicare UPIN
NYZ62341Medicare ID - Type Unspecified