Provider Demographics
NPI:1568578920
Name:EYE CONSULTANTS OF SYRACUSE PC
Entity Type:Organization
Organization Name:EYE CONSULTANTS OF SYRACUSE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:SPITZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-422-4412
Mailing Address - Street 1:5792 WIDEWATERS PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13214-1847
Mailing Address - Country:US
Mailing Address - Phone:315-422-4412
Mailing Address - Fax:
Practice Address - Street 1:5792 WIDEWATERS PKWY STE 101
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13214-1847
Practice Address - Country:US
Practice Address - Phone:315-422-4412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2019-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01644040Medicaid
NY0723110001Medicare NSC
NY34586AMedicare ID - Type Unspecified