Basic Information
| Provider Information | |||||||||
| NPI: | 1194814558 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EYE ASSOCIATES,PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 AARON CT | ||||||||
| Address2: | |||||||||
| City: | KINGSTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 124012966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453310711 | ||||||||
| FaxNumber: | 8453349338 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 AARON CT | ||||||||
| Address2: | |||||||||
| City: | KINGSTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 124012966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453310711 | ||||||||
| FaxNumber: | 8453349338 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 01/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | POTTER | ||||||||
| AuthorizedOfficialFirstName: | ANGELA | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8453310711 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 01961935 | 05 | NY | MEDICAID |