Provider Demographics
NPI:1841414844
Name:CAPITAL REGION EYE SPECIALIST AND SURGEON PLLC
Entity Type:Organization
Organization Name:CAPITAL REGION EYE SPECIALIST AND SURGEON PLLC
Other - Org Name:CORNEA CONSULTANTS OF ALBANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHULTZE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-475-1515
Mailing Address - Street 1:1220 NEW SCOTLAND RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-9386
Mailing Address - Country:US
Mailing Address - Phone:518-475-1515
Mailing Address - Fax:518-475-0645
Practice Address - Street 1:1220 NEW SCOTLAND RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SLINGERLANDS
Practice Address - State:NY
Practice Address - Zip Code:12159-9386
Practice Address - Country:US
Practice Address - Phone:518-475-1515
Practice Address - Fax:518-475-0645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01827834Medicaid
NYJ100012555Medicare PIN