Provider Demographics
NPI:1619407517
Name:SOUTHTOWNS OPHTHALMOLOGY PC
Entity Type:Organization
Organization Name:SOUTHTOWNS OPHTHALMOLOGY PC
Other - Org Name:SOUTHTOWNS EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLISSERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-674-6030
Mailing Address - Street 1:3151 SOUTHWESTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1212
Mailing Address - Country:US
Mailing Address - Phone:716-674-6030
Mailing Address - Fax:716-674-6052
Practice Address - Street 1:3151 SOUTHWESTERN BLVD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1212
Practice Address - Country:US
Practice Address - Phone:716-674-6030
Practice Address - Fax:716-674-6052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135023207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty