Provider Demographics
NPI:1639393077
Name:MASTERMAN EYE CARE
Entity Type:Organization
Organization Name:MASTERMAN EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OPT
Authorized Official - Phone:315-834-9841
Mailing Address - Street 1:8934 N SENECA ST
Mailing Address - Street 2:P O BOX 678
Mailing Address - City:WEEDSPORT
Mailing Address - State:NY
Mailing Address - Zip Code:13166-8566
Mailing Address - Country:US
Mailing Address - Phone:315-834-8941
Mailing Address - Fax:
Practice Address - Street 1:8934 N SENECA ST
Practice Address - Street 2:
Practice Address - City:WEEDSPORT
Practice Address - State:NY
Practice Address - Zip Code:13166-8566
Practice Address - Country:US
Practice Address - Phone:315-834-8941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00610302Medicaid
NY02186423Medicaid