MEDICARE: CHENANGO EYE ASSOCIATES PHYSICIANS & SURGEONS 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	332H00000X	Eyewear Supplier		NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1185030001	OTHER	NY	DMERC SUPPLIER #

General Provider Information

NPI Number	:	1912082587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHENANGO EYE ASSOCIATES PHYSICIANS & SURGEONS PC

Provider Business Mailing Address
First Line	:	194 GRANDVIEW LN
Second Line	:
City	:	NORWICH
State	:	NY
Zip	:	13815-3331
Country	:	US
Telephone Number	:	607-334-3225
Fax Number	:

Provider Business Practice Location Address
First Line	:	194 GRANDVIEW LN
Second Line	:
City	:	NORWICH
State	:	NY
Zip	:	13815-3331
Country	:	US
Telephone Number	:	607-334-3225
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	MS. SARAH POTTER
Credential	:
Telephone Number	:	607-334-3225

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	05/22/2023

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