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General NPI Number Information
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NPI Number | 1093730087
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Entity Type | Organization
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Legal Business Name | KANSAS EYE SURGERY ASSOCIATES, P.C.
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 24 CENTURY HILL DR SUITE 001
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City | LATHAM
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State | NY
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Zip | 12110-2133
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Country | US
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Telephone | 518-690-2015
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Fax | 518-690-0353
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Provider Business Mailing Address
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Address Line | 24 CENTURY HILL DR SUITE 001
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City | LATHAM
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State | NY
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Zip | 12110-2133
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Country | US
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Telephone | 518-690-2015
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Fax | 518-690-0353
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Authorized Official
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Title or Position | OWNER
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Name | DR. PETER GEORGE KANSAS
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Credential | M.D.
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Telephone | 518-690-2015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 092366
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License Number State | NY
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