Provider Demographics
NPI:1528156817
Name:ST. CROIX EYE GROUP, INC.
Entity type:Organization
Organization Name:ST. CROIX EYE GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANDUZE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:340-773-2015
Mailing Address - Street 1:PO BOX 3019
Mailing Address - Street 2:
Mailing Address - City:KINGSHILL
Mailing Address - State:VI
Mailing Address - Zip Code:00851-3019
Mailing Address - Country:US
Mailing Address - Phone:340-773-2015
Mailing Address - Fax:340-719-9590
Practice Address - Street 1:4500 SUNNY ISLE
Practice Address - Street 2:ISLAND MEDICAL CENTER
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-4493
Practice Address - Country:US
Practice Address - Phone:340-773-2015
Practice Address - Fax:340-719-9590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI1132Medicaid
VI1132Medicaid