Provider Demographics
NPI:1194893776
Name:EAST FISHKILL EYE ASSOCIATES OPTOMETRISTS, P.C.
Entity type:Organization
Organization Name:EAST FISHKILL EYE ASSOCIATES OPTOMETRISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROODNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:845-227-2233
Mailing Address - Street 1:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533
Mailing Address - Country:US
Mailing Address - Phone:845-227-2233
Mailing Address - Fax:845-227-4186
Practice Address - Street 1:857 ROUTE 82
Practice Address - Street 2:
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533
Practice Address - Country:US
Practice Address - Phone:845-227-2233
Practice Address - Fax:845-227-4186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004051152W00000X
NYTUV004725152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC2T431OtherBLUE CROSS BLUE SHIELD
NYC2T441OtherBLUE CROSS BLUE SHIELD
NY1151030001Medicare NSC
NYC2T431OtherBLUE CROSS BLUE SHIELD