Provider Demographics
NPI:1598748659
Name:OMNI EYE SURGERY OF NEW YORK PC
Entity Type:Organization
Organization Name:OMNI EYE SURGERY OF NEW YORK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:K
Authorized Official - Last Name:GRAYSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-353-0030
Mailing Address - Street 1:20 E 46TH ST
Mailing Address - Street 2:PENTHOUSE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-2417
Mailing Address - Country:US
Mailing Address - Phone:212-353-0030
Mailing Address - Fax:212-353-0083
Practice Address - Street 1:20 E 46TH ST
Practice Address - Street 2:PENTHOUSE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-2417
Practice Address - Country:US
Practice Address - Phone:212-353-0030
Practice Address - Fax:212-353-0083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ057051Medicare PIN
NYW35781Medicare ID - Type Unspecified
NY057051Medicare PIN