Provider Demographics
NPI:1801014394
Name:M B KAYANI PHYSICIAN PC
Entity Type:Organization
Organization Name:M B KAYANI PHYSICIAN PC
Other - Org Name:DBA WATERTOWN EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NOAMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-788-6070
Mailing Address - Street 1:1815 STATE ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-9406
Mailing Address - Country:US
Mailing Address - Phone:315-788-6070
Mailing Address - Fax:315-788-1950
Practice Address - Street 1:77 W BARNEY ST
Practice Address - Street 2:
Practice Address - City:GOUVERNEUR
Practice Address - State:NY
Practice Address - Zip Code:13642-1040
Practice Address - Country:US
Practice Address - Phone:315-287-3638
Practice Address - Fax:315-287-3656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199713207W00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0299260002Medicare NSC
NY52833AMedicare PIN