Provider Demographics
NPI:1427065515
Name:ROCHESTER EYE CARE GROUP PC
Entity type:Organization
Organization Name:ROCHESTER EYE CARE GROUP PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:BALDICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-232-2560
Mailing Address - Street 1:1400 PORTLAND AVE
Mailing Address - Street 2:SUITE 20
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3014
Mailing Address - Country:US
Mailing Address - Phone:585-232-2560
Mailing Address - Fax:
Practice Address - Street 1:1400 PORTLAND AVE
Practice Address - Street 2:SUITE 20
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3014
Practice Address - Country:US
Practice Address - Phone:585-232-2560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP017960059OtherEXCELLUS BLUE CHOICE
NY103358CTOtherPREFERRED CARE
NYP017960059OtherEXCELLUS BLUE CHOICE