Provider Demographics
NPI:1295755627
Name:FINGER LAKES OPHTHALMOLOGY, PC
Entity type:Organization
Organization Name:FINGER LAKES OPHTHALMOLOGY, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNGJUN
Authorized Official - Middle Name:
Authorized Official - Last Name:HWANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-394-2020
Mailing Address - Street 1:325 WEST ST
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1723
Mailing Address - Country:US
Mailing Address - Phone:585-394-2020
Mailing Address - Fax:585-394-9261
Practice Address - Street 1:325 WEST ST
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1723
Practice Address - Country:US
Practice Address - Phone:585-394-2020
Practice Address - Fax:585-394-9261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03331468Medicaid