Healthcare Provider Details

I. General information

NPI: 1063427847
Provider Name (Legal Business Name): NORTH SHORE MEDICAL & SURGICAL EYE CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 07/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 MIDDLE COUNTRY RD STE 201
SMITHTOWN NY
11787
US

IV. Provider business mailing address

260 MIDDLE COUNTRY RD STE 201
SMITHTOWN NY
11787
US

V. Phone/Fax

Practice location:
  • Phone: 631-265-8780
  • Fax: 631-265-8521
Mailing address:
  • Phone: 631-265-8780
  • Fax: 631-265-8521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY L MARTIN
Title or Position: OPTHAMOLOGIST
Credential: MD
Phone: 631-265-8780