Provider Demographics
NPI:1386082360
Name:EHSOC
Entity type:Organization
Organization Name:EHSOC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COOWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:LEVINSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD,
Authorized Official - Phone:315-455-8933
Mailing Address - Street 1:105 NELSON ST STE 2
Mailing Address - Street 2:
Mailing Address - City:CAZENOVIA
Mailing Address - State:NY
Mailing Address - Zip Code:13035-1352
Mailing Address - Country:US
Mailing Address - Phone:315-655-4964
Mailing Address - Fax:315-655-2662
Practice Address - Street 1:105 NELSON ST STE 2
Practice Address - Street 2:
Practice Address - City:CAZENOVIA
Practice Address - State:NY
Practice Address - Zip Code:13035-1352
Practice Address - Country:US
Practice Address - Phone:315-655-4964
Practice Address - Fax:315-655-2662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT005365152W00000X
NY007004152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU36952Medicare UPIN
NYV08619Medicare UPIN