Provider Demographics
NPI:1770511776
Name:KANSAS EYE SURGERY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:KANSAS EYE SURGERY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVIE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KWIAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-690-2015
Mailing Address - Street 1:24 CENTURY HILL DR
Mailing Address - Street 2:SUITE 001
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2133
Mailing Address - Country:US
Mailing Address - Phone:518-690-2015
Mailing Address - Fax:581-690-0353
Practice Address - Street 1:24 CENTURY HILL DR
Practice Address - Street 2:SUITE 001
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2133
Practice Address - Country:US
Practice Address - Phone:518-690-2015
Practice Address - Fax:581-690-0353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226627174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02684013Medicaid
NY02684013Medicaid
NY141698Medicare UPIN