MEDICARE: EYE SURGEON PC

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	205493	NY

General Provider Information

NPI Number	:	1477635993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE SURGEON PC

Provider Business Mailing Address
First Line	:	485 PARK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-1228
Country	:	US
Telephone Number	:	212-753-6464
Fax Number	:	212-753-6469

Provider Business Practice Location Address
First Line	:	485 PARK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-1228
Country	:	US
Telephone Number	:	212-753-6464
Fax Number	:	212-753-6469

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHARLES A. COLE
Credential	:	M.D.
Telephone Number	:	212-753-6464

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	08/22/2020

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