Provider Demographics
NPI:1659465805
Name:SUSSEX EYE CARE & MEDICAL ASSOCIATES PA
Entity Type:Organization
Organization Name:SUSSEX EYE CARE & MEDICAL ASSOCIATES PA
Other - Org Name:ATLANTIC EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLDOLFO
Authorized Official - Middle Name:J
Authorized Official - Last Name:RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-644-8007
Mailing Address - Street 1:1306 SAVANNAH RD
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1526
Mailing Address - Country:US
Mailing Address - Phone:302-644-8007
Mailing Address - Fax:302-644-2797
Practice Address - Street 1:1306 SAVANNAH RD
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1526
Practice Address - Country:US
Practice Address - Phone:302-644-8007
Practice Address - Fax:302-644-2797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10005278207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG01723Medicare UPIN
DE1321080001Medicare NSC