Provider Demographics
NPI:1760661524
Name:PRIMARY EYECARE OPTOMETRY PC
Entity Type:Organization
Organization Name:PRIMARY EYECARE OPTOMETRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:N
Authorized Official - Last Name:LIEDER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:845-356-3166
Mailing Address - Street 1:75 COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-2436
Mailing Address - Country:US
Mailing Address - Phone:845-356-3166
Mailing Address - Fax:845-356-3201
Practice Address - Street 1:75 COLLEGE RD
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-2436
Practice Address - Country:US
Practice Address - Phone:845-356-3166
Practice Address - Fax:845-356-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0035661152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC26251Medicare PIN
NY0152740001Medicare NSC