MEDICARE: LONG ISLAND EYE PHYSICIANS & SURGEONS,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

General Provider Information

NPI Number	:	1639396633
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONG ISLAND EYE PHYSICIANS & SURGEONS,PC

Provider Business Mailing Address
First Line	:	251 E OAKLAND AVE
Second Line	:
City	:	PORT JEFFERSON
State	:	NY
Zip	:	11777-2166
Country	:	US
Telephone Number	:	631-473-5329
Fax Number	:	631-473-5371

Provider Business Practice Location Address
First Line	:	251 E OAKLAND AVE
Second Line	:
City	:	PORT JEFFERSON
State	:	NY
Zip	:	11777-2166
Country	:	US
Telephone Number	:	631-473-5329
Fax Number	:	631-473-5371

Authorized Official
Title or Position	:	OPHTHALMOLOGIST
Name	:	DR. GERALD SAUL STOLLER
Credential	:	M.D.
Telephone Number	:	631-473-5329

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	03/06/2008

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