Provider Demographics
NPI:1730132291
Name:ROBERT K DRUGER MD PLLC
Entity Type:Organization
Organization Name:ROBERT K DRUGER MD PLLC
Other - Org Name:DRUGER EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:DRUGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-488-1601
Mailing Address - Street 1:5633 W GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-1324
Mailing Address - Country:US
Mailing Address - Phone:315-488-1601
Mailing Address - Fax:315-488-0047
Practice Address - Street 1:5633 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-1324
Practice Address - Country:US
Practice Address - Phone:315-488-1601
Practice Address - Fax:315-488-0047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006882152W00000X
NY210355207W00000X
NY260483207W00000X
NYC005879332B00000X
NY006685332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5244700001Medicare NSC
NYBA0254Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER #
NY5244700001Medicare NSC