=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972532778
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GLENS FALLS EYE ASSOCIATES, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2006
-----------------------------------------------------
Last Update Date | 06/21/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 535 BAY RD
-----------------------------------------------------
City | QUEENSBURY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-793-0331
-----------------------------------------------------
Fax | 518-793-7986
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 535 BAY RD
-----------------------------------------------------
City | QUEENSBURY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12804-3018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-793-0331
-----------------------------------------------------
Fax | 518-793-7986
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MARK H HITE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 518-793-0331
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------