Provider Demographics
NPI:1245327550
Name:ROCHESTER EYE CARE GROUP, PC
Entity type:Organization
Organization Name:ROCHESTER EYE CARE GROUP, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BALDICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-546-7610
Mailing Address - Street 1:30 N UNION ST
Mailing Address - Street 2:101
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-1345
Mailing Address - Country:US
Mailing Address - Phone:585-232-2560
Mailing Address - Fax:585-232-6446
Practice Address - Street 1:30 N UNION ST
Practice Address - Street 2:101
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1345
Practice Address - Country:US
Practice Address - Phone:585-232-2560
Practice Address - Fax:585-232-6446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01750756Medicaid
NYG0189600590OtherEXCELLUS BLUE CHOICE
NY1207650002Medicare NSC
NY31536AMedicare ID - Type UnspecifiedGROUP #
NY01750756Medicaid