Provider Demographics
NPI:1609943604
Name:PECORA OPHTHALMOLOGY PRACTICE PLLC
Entity Type:Organization
Organization Name:PECORA OPHTHALMOLOGY PRACTICE PLLC
Other - Org Name:EYE SIGHT ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CPC
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:B
Authorized Official - Last Name:QUEZADA
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:607-785-3043
Mailing Address - Street 1:1207 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-5219
Mailing Address - Country:US
Mailing Address - Phone:607-785-3043
Mailing Address - Fax:607-785-9093
Practice Address - Street 1:1207 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-5219
Practice Address - Country:US
Practice Address - Phone:607-785-3043
Practice Address - Fax:607-785-9093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY059345809OtherBLUE SHIELD CNY
PA038534Medicare PIN
NY059345809OtherBLUE SHIELD CNY