Provider Demographics
NPI:1295723534
Name:SYRACUSE EYE PHYSICIANS,LLP
Entity type:Organization
Organization Name:SYRACUSE EYE PHYSICIANS,LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:JESSE
Authorized Official - Last Name:HANIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-472-4467
Mailing Address - Street 1:716 JAMES STREET
Mailing Address - Street 2:STE 108
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203
Mailing Address - Country:US
Mailing Address - Phone:315-472-4467
Mailing Address - Fax:315-472-0197
Practice Address - Street 1:716 JAMES ST
Practice Address - Street 2:STE 108
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2087
Practice Address - Country:US
Practice Address - Phone:315-472-4467
Practice Address - Fax:315-472-0197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00900358Medicaid
NY00900358Medicaid
1242010001Medicare NSC
NYJ100000350Medicare UPIN