Healthcare Provider Details

I. General information

NPI: 1912900366
Provider Name (Legal Business Name): OPHTHALMOLOGICAL ASSOCIATES OF SYRACUSE MD,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 UNIVERSITY AVE
SYRACUSE NY
13210-1807
US

IV. Provider business mailing address

612 UNIVERSITY AVE
SYRACUSE NY
13210-1807
US

V. Phone/Fax

Practice location:
  • Phone: 315-422-2020
  • Fax: 315-422-7364
Mailing address:
  • Phone: 315-422-2020
  • Fax: 315-422-7364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number114783-1
License Number StateNY

VIII. Authorized Official

Name: DR. JOHN A HOEPNER
Title or Position: PRESIDENT
Credential: MD
Phone: 315-422-2020