Provider Demographics
NPI:1821042664
Name:DOWNSTATE OPHTHALMOLOGY ASSOCIATES, PC
Entity Type:Organization
Organization Name:DOWNSTATE OPHTHALMOLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:FRED
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-638-2020
Mailing Address - Street 1:11 PLAZA ST W
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-3706
Mailing Address - Country:US
Mailing Address - Phone:718-638-2020
Mailing Address - Fax:718-230-3429
Practice Address - Street 1:11 PLAZA ST W
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-3706
Practice Address - Country:US
Practice Address - Phone:718-638-2020
Practice Address - Fax:718-230-3429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01228528Medicaid
NYWFE451Medicare ID - Type Unspecified