Provider Demographics
NPI:1093001414
Name:EMERGENCY OPTHAMOLOGY SERVICES PC
Entity type:Organization
Organization Name:EMERGENCY OPTHAMOLOGY SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FROMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-289-1559
Mailing Address - Street 1:550 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7369
Mailing Address - Country:US
Mailing Address - Phone:212-832-9228
Mailing Address - Fax:
Practice Address - Street 1:550 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7369
Practice Address - Country:US
Practice Address - Phone:714-289-1559
Practice Address - Fax:714-289-0280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174683-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY14F491Medicare PIN