Provider Demographics
NPI:1912022427
Name:MILLENNIUM OPHTHALMOLOGY
Entity Type:Organization
Organization Name:MILLENNIUM OPHTHALMOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-371-1550
Mailing Address - Street 1:271 DOUGHTY BLVD
Mailing Address - Street 2:
Mailing Address - City:INWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11096-2135
Mailing Address - Country:US
Mailing Address - Phone:516-371-1550
Mailing Address - Fax:
Practice Address - Street 1:271 DOUGHTY BLVD
Practice Address - Street 2:
Practice Address - City:INWOOD
Practice Address - State:NY
Practice Address - Zip Code:11096-2135
Practice Address - Country:US
Practice Address - Phone:516-371-1550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200408207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01856959Medicaid
NYWEA581Medicare PIN
NYG72276Medicare UPIN
NY08083Medicare PIN