Provider Demographics
NPI:1811025281
Name:KWIAT OPHTHALMOLOGY PLLC
Entity Type:Organization
Organization Name:KWIAT OPHTHALMOLOGY PLLC
Other - Org Name:KWIAT EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:KWIAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-265-1610
Mailing Address - Street 1:11 CALAIS DR
Mailing Address - Street 2:
Mailing Address - City:WHITESBORO
Mailing Address - State:NY
Mailing Address - Zip Code:13492-2508
Mailing Address - Country:US
Mailing Address - Phone:315-736-8698
Mailing Address - Fax:
Practice Address - Street 1:234 THORNBERRY LN
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:NY
Practice Address - Zip Code:12144-8452
Practice Address - Country:US
Practice Address - Phone:315-736-8698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226627207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10099697OtherCDPHP