Provider Demographics
NPI:1104924752
Name:EYECARE CENTER OF MEXICO, INC.
Entity type:Organization
Organization Name:EYECARE CENTER OF MEXICO, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHELSEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-963-8233
Mailing Address - Street 1:57 NORTH ST
Mailing Address - Street 2:PO BOX 368
Mailing Address - City:MEXICO
Mailing Address - State:NY
Mailing Address - Zip Code:13114-4302
Mailing Address - Country:US
Mailing Address - Phone:315-963-8233
Mailing Address - Fax:315-963-7209
Practice Address - Street 1:57 NORTH ST
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:NY
Practice Address - Zip Code:13114-4302
Practice Address - Country:US
Practice Address - Phone:315-963-8233
Practice Address - Fax:315-963-7209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006428152W00000X
NYTUV003386152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0089Medicare ID - Type Unspecified