MEDICARE: EYE PLASTIC AND RECONSTRUCTIVE SURGERY OF CNY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician
2	207WX0200X	Ophthalmic Plastic and Reconstructive Surgery Physician

General Provider Information

NPI Number	:	1548351935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE PLASTIC AND RECONSTRUCTIVE SURGERY OF CNY PC

Provider Business Mailing Address
First Line	:	PO BOX 2003
Second Line	:
City	:	EAST SYRACUSE
State	:	NY
Zip	:	13057-4503
Country	:	US
Telephone Number	:	315-446-3904
Fax Number	:	315-445-2936

Provider Business Practice Location Address
First Line	:	3400 VICKERY RD
Second Line	:	SUITE A
City	:	NORTH SYRACUSE
State	:	NY
Zip	:	13212-4540
Country	:	US
Telephone Number	:	315-422-3937
Fax Number	:	315-422-4432

Authorized Official
Title or Position	:	OWNER
Name	:	THOMAS A BERSANI
Credential	:	MD
Telephone Number	:	315-422-3937

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	03/19/2025

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