Provider Demographics
NPI:1063420388
Name:SOUTHERN DUTCHESS EYECARE, LLP
Entity type:Organization
Organization Name:SOUTHERN DUTCHESS EYECARE, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:PERALTA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:845-896-6700
Mailing Address - Street 1:969 MAIN ST STE H
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-1791
Mailing Address - Country:US
Mailing Address - Phone:845-896-6700
Mailing Address - Fax:845-896-6882
Practice Address - Street 1:969 MAIN ST STE H
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-1791
Practice Address - Country:US
Practice Address - Phone:845-896-6700
Practice Address - Fax:845-896-6882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004490152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC5W921Medicare PIN
NY1166630001Medicare NSC