Provider Demographics
NPI:1992015903
Name:NEW YORK EYE INSTITUTE AND LASER VISION CENTER, LLC
Entity Type:Organization
Organization Name:NEW YORK EYE INSTITUTE AND LASER VISION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AYMAN
Authorized Official - Middle Name:Z
Authorized Official - Last Name:MATTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-692-7066
Mailing Address - Street 1:90 CRYSTAL RUN RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-7101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:90 CRYSTAL RUN RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-7101
Practice Address - Country:US
Practice Address - Phone:845-692-7066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-12
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215965207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02215396Medicaid
NY02215396Medicaid
NY455A61Medicare PIN