Provider Demographics
NPI:1710326921
Name:NORTH SHORE SOUTHOLD MEDICAL AND SURGICAL EYE CARE PC
Entity Type:Organization
Organization Name:NORTH SHORE SOUTHOLD MEDICAL AND SURGICAL EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-265-8780
Mailing Address - Street 1:41705 COUNTY ROAD 48
Mailing Address - Street 2:
Mailing Address - City:SOUTHOLD
Mailing Address - State:NY
Mailing Address - Zip Code:11971-5016
Mailing Address - Country:US
Mailing Address - Phone:631-265-8780
Mailing Address - Fax:631-265-8521
Practice Address - Street 1:41705 COUNTY ROAD 48
Practice Address - Street 2:
Practice Address - City:SOUTHOLD
Practice Address - State:NY
Practice Address - Zip Code:11971-5016
Practice Address - Country:US
Practice Address - Phone:631-265-8780
Practice Address - Fax:631-265-8521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty