Provider Demographics
NPI:1619156668
Name:CORRECTIONAL EYE CARE NETWORK
Entity Type:Organization
Organization Name:CORRECTIONAL EYE CARE NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:518-479-4722
Mailing Address - Street 1:2 MIDDLESEX RD
Mailing Address - Street 2:
Mailing Address - City:EAST GREENBUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12061-2504
Mailing Address - Country:US
Mailing Address - Phone:518-479-4722
Mailing Address - Fax:518-479-4725
Practice Address - Street 1:2 MIDDLESEX RD
Practice Address - Street 2:
Practice Address - City:EAST GREENBUSH
Practice Address - State:NY
Practice Address - Zip Code:12061-2504
Practice Address - Country:US
Practice Address - Phone:518-479-4722
Practice Address - Fax:518-479-4725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0005420152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty