Provider Demographics
NPI:1811397433
Name:EYE PHYSICIANS OF ORANGE COUNTY, PC
Entity Type:Organization
Organization Name:EYE PHYSICIANS OF ORANGE COUNTY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-294-5128
Mailing Address - Street 1:1 HATFIELD LANE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-6753
Mailing Address - Country:US
Mailing Address - Phone:845-294-5128
Mailing Address - Fax:845-294-1479
Practice Address - Street 1:32 CANAL ST
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-1638
Practice Address - Country:US
Practice Address - Phone:845-672-3960
Practice Address - Fax:845-672-3157
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE PHYSICIANS OF ORANGE COUNTY PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-02
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207W00000X
NY149367207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG67744Medicare UPIN
NYB19006Medicare UPIN
NC2075907Medicare PIN
NYB15161Medicare UPIN
NYB80454Medicare UPIN