Provider Demographics
NPI:1699892976
Name:LONG ISLAND EYE SURGEONS, PC
Entity type:Organization
Organization Name:LONG ISLAND EYE SURGEONS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-627-5113
Mailing Address - Street 1:2110 NORTHERN BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3502
Mailing Address - Country:US
Mailing Address - Phone:516-627-5113
Mailing Address - Fax:516-365-2817
Practice Address - Street 1:2110 NORTHERN BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3502
Practice Address - Country:US
Practice Address - Phone:516-627-5113
Practice Address - Fax:516-365-2817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109382207W00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4565690001Medicare ID - Type Unspecified