Provider Demographics
NPI:1629065735
Name:OPHTHALMOLOGICAL ASSOCIATES OF SRACUSE
Entity Type:Organization
Organization Name:OPHTHALMOLOGICAL ASSOCIATES OF SRACUSE
Other - Org Name:OCUTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:F.
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-422-6214
Mailing Address - Street 1:612 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1807
Mailing Address - Country:US
Mailing Address - Phone:315-422-6214
Mailing Address - Fax:
Practice Address - Street 1:612 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1807
Practice Address - Country:US
Practice Address - Phone:315-422-6214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4990738332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0875860002Medicare ID - Type Unspecified