Provider Demographics
NPI:1780194407
Name:COHOES EYE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:COHOES EYE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIMEAU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:518-233-0463
Mailing Address - Street 1:91 MOHAWK ST
Mailing Address - Street 2:
Mailing Address - City:COHOES
Mailing Address - State:NY
Mailing Address - Zip Code:12047
Mailing Address - Country:US
Mailing Address - Phone:518-237-0342
Mailing Address - Fax:518-235-9266
Practice Address - Street 1:91 MOHAWK ST
Practice Address - Street 2:
Practice Address - City:COHOES
Practice Address - State:NY
Practice Address - Zip Code:12047-2809
Practice Address - Country:US
Practice Address - Phone:518-237-0342
Practice Address - Fax:518-235-9266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-08
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005872152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU70980OtherUPIN
NY02133640Medicaid