Provider Demographics
NPI:1386709434
Name:CENTRAL NEW YORK EYE CENTER
Entity type:Organization
Organization Name:CENTRAL NEW YORK EYE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:WOODOCOCK
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:315-452-2212
Mailing Address - Street 1:5100 W TAFT RD STE 3L
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-3809
Mailing Address - Country:US
Mailing Address - Phone:315-452-2212
Mailing Address - Fax:315-452-2231
Practice Address - Street 1:5100 W TAFT RD STE 3L
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-3809
Practice Address - Country:US
Practice Address - Phone:315-452-2212
Practice Address - Fax:315-452-2231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112637-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY52997AMedicare ID - Type Unspecified