Provider Demographics
NPI:1912900366
Name:OPHTHALMOLOGICAL ASSOCIATES OF SYRACUSE MD,PC
Entity Type:Organization
Organization Name:OPHTHALMOLOGICAL ASSOCIATES OF SYRACUSE MD,PC
Other - Org Name:SYRACUSE EYE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOEPNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-422-2020
Mailing Address - Street 1:612 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1807
Mailing Address - Country:US
Mailing Address - Phone:315-422-2020
Mailing Address - Fax:315-422-7364
Practice Address - Street 1:612 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1807
Practice Address - Country:US
Practice Address - Phone:315-422-2020
Practice Address - Fax:315-422-7364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114783-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01524143Medicaid
NY01524143Medicaid