MEDICARE: OPHTHALMIC PLASTIC SURGERY,PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CJ5282	OTHER	NY	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1235113424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPHTHALMIC PLASTIC SURGERY,PLLC

Provider Business Mailing Address
First Line	:	PO BOX 700
Second Line	:
City	:	SLINGERLANDS
State	:	NY
Zip	:	12159-0700
Country	:	US
Telephone Number	:	518-533-6540
Fax Number	:	518-533-6542

Provider Business Practice Location Address
First Line	:	1220 NEW SCOTLAND RD
Second Line	:	SUITE 302
City	:	SLINGERLANDS
State	:	NY
Zip	:	12159-9208
Country	:	US
Telephone Number	:	518-533-6540
Fax Number	:	518-533-6542

Authorized Official
Title or Position	:	OPHTHALMOLOGIST
Name	:	DR. DALE R MEYER
Credential	:	M.D.
Telephone Number	:	518-533-6540

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	10/24/2007

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