=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427468859
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SIRGANY EYECARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2014
-----------------------------------------------------
Last Update Date | 05/07/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 MCLEAN RD
-----------------------------------------------------
City | CORTLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13045-3509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-749-2020
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 MCLEAN RD
-----------------------------------------------------
City | CORTLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13045-3509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-749-2020
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. BRIAN SIRGANY
-----------------------------------------------------
Credential | OD, FAAO
-----------------------------------------------------
Telephone | 607-749-2020
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | TUV 006874
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------