MEDICARE: EYE CONSULTANTS OF SYRACUSE PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	152W00000X	Optometrist
2	174400000X	Specialist
3	207W00000X	Ophthalmology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568578920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE CONSULTANTS OF SYRACUSE PC

Provider Business Mailing Address
First Line	:	5792 WIDEWATERS PKWY STE 101
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13214-1847
Country	:	US
Telephone Number	:	315-422-4412
Fax Number	:

Provider Business Practice Location Address
First Line	:	5792 WIDEWATERS PKWY STE 101
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13214-1847
Country	:	US
Telephone Number	:	315-422-4412
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	STEPHEN G SPITZER
Credential	:
Telephone Number	:	315-422-4412

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	04/27/2019

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