Provider Demographics
NPI:1942318563
Name:PEDIATRIC OPHTHALMOLOGY P.C.
Entity Type:Organization
Organization Name:PEDIATRIC OPHTHALMOLOGY P.C.
Other - Org Name:PEDIATRIC EYE MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:LICHTENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-468-9800
Mailing Address - Street 1:19213 UNION TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366
Mailing Address - Country:US
Mailing Address - Phone:718-468-9800
Mailing Address - Fax:718-468-0600
Practice Address - Street 1:19213 UNION TPKE
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1865
Practice Address - Country:US
Practice Address - Phone:718-468-9800
Practice Address - Fax:718-468-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
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
NYWEH761Medicare ID - Type Unspecified