Provider Demographics
NPI:1619906252
Name:ROCHESTER EYE ASSOCIATES PHYSICIANS AND SURGEONS PC
Entity Type:Organization
Organization Name:ROCHESTER EYE ASSOCIATES PHYSICIANS AND SURGEONS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-244-0332
Mailing Address - Street 1:2301 LAC DE VILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-5646
Mailing Address - Country:US
Mailing Address - Phone:585-244-0332
Mailing Address - Fax:585-473-8833
Practice Address - Street 1:2301 LAC DE VILLE BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-5646
Practice Address - Country:US
Practice Address - Phone:585-244-0332
Practice Address - Fax:585-473-8833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0610260002Medicare NSC
14474AMedicare PIN
0610260001Medicare NSC