Provider Demographics
NPI:1881725810
Name:EYE SURGEONS OF CENTRAL NEW YORK, PC
Entity type:Organization
Organization Name:EYE SURGEONS OF CENTRAL NEW YORK, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHIP
Authorized Official - Middle Name:J
Authorized Official - Last Name:VANALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-382-4284
Mailing Address - Street 1:5100 W. TAFT ROAD, SUITE 4M
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088
Mailing Address - Country:US
Mailing Address - Phone:315-362-3937
Mailing Address - Fax:315-458-7818
Practice Address - Street 1:5100 W TAFT RD STE 4M
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-3810
Practice Address - Country:US
Practice Address - Phone:315-362-3937
Practice Address - Fax:315-458-7818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005797-1152W00000X
152W00000X
NY154663-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
J400343664Medicare PIN
34609FMedicare PIN
J400130069Medicare PIN