Provider Demographics
NPI:1760736888
Name:COMPREHENSIVE EYECARE AND SURGERY, LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE EYECARE AND SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ICASIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-334-7907
Mailing Address - Street 1:450 W 17TH ST
Mailing Address - Street 2:#711
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-5811
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 CENTRAL AVE
Practice Address - Street 2:# 220
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-5302
Practice Address - Country:US
Practice Address - Phone:917-334-7907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08227200207W00000X
NY243702207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty