Provider Demographics
NPI:1578777199
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:EYE CARE FOR THE ADIRONDACKS
Other - Org Type:Doing Business As
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 STREET
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901
Mailing Address - Country:US
Mailing Address - Phone:518-566-2020
Mailing Address - Fax:518-561-5390
Practice Address - Street 1:450 MARGARET STREET
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901
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:2007-05-10
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0693520001Medicare NSC