Provider Demographics
NPI:1063697043
Name:EYECARE BY OPHTHALMOLOGIST, PLLC
Entity type:Organization
Organization Name:EYECARE BY OPHTHALMOLOGIST, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TUNG
Authorized Official - Middle Name:T
Authorized Official - Last Name:CHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-886-8830
Mailing Address - Street 1:8130 254TH ST
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1438
Mailing Address - Country:US
Mailing Address - Phone:718-886-8830
Mailing Address - Fax:
Practice Address - Street 1:755 NEW YORK AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-4240
Practice Address - Country:US
Practice Address - Phone:718-886-8830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2015-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211188207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY71114000050OtherFIDELIS CARE
NY211188E16OtherHEALTH FIRST
NY5666435OtherFIRST HEALTH
NY0498119OtherGHI
NY107851OtherGHI HMO
NY8H1762OtherEMPIRE BLUE CROSS/BS
NY07041Medicare PIN
NY107851OtherGHI HMO