Provider Demographics
NPI:1104901560
Name:CHENANGO EYE ASSOCIATES PHYSICIANS & SURGEONS PC
Entity type:Organization
Organization Name:CHENANGO EYE ASSOCIATES PHYSICIANS & SURGEONS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-334-3225
Mailing Address - Street 1:194 GRANDVIEW LN
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-3331
Mailing Address - Country:US
Mailing Address - Phone:607-334-3225
Mailing Address - Fax:
Practice Address - Street 1:4 EATON ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NY
Practice Address - Zip Code:13346-1102
Practice Address - Country:US
Practice Address - Phone:315-824-8362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHENANGO EYE ASSOCIATES PHYSICIANS & SURGEONS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-26
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1185030002OtherDMERC
NY51699AMedicare UPIN