Provider Demographics
NPI:1841410495
Name:SURGICAL EYE CARE PLLC
Entity Type:Organization
Organization Name:SURGICAL EYE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DELPHINE
Authorized Official - Middle Name:S
Authorized Official - Last Name:WINTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-891-5189
Mailing Address - Street 1:86 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-5736
Mailing Address - Country:US
Mailing Address - Phone:518-891-5189
Mailing Address - Fax:518-891-1992
Practice Address - Street 1:86 MAIN ST
Practice Address - Street 2:
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-5736
Practice Address - Country:US
Practice Address - Phone:518-891-5189
Practice Address - Fax:518-891-1992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168303207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY180038045OtherMEDICARE RR
NY4464390004Medicare NSC
NY180038045Medicare PIN