MEDICARE: EYE PHYSICIANS OF ORANGE COUNTY, 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
2	207W00000X	Ophthalmology Physician	149367	NY

General Provider Information

NPI Number	:	1811397433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE PHYSICIANS OF ORANGE COUNTY, PC

Provider Business Mailing Address
First Line	:	1 HATFIELD LANE
Second Line	:	SUITE 3
City	:	GOSHEN
State	:	NY
Zip	:	10924-6753
Country	:	US
Telephone Number	:	845-294-5128
Fax Number	:	845-294-1479

Provider Business Practice Location Address
First Line	:	32 CANAL ST
Second Line	:
City	:	PORT JERVIS
State	:	NY
Zip	:	12771-1638
Country	:	US
Telephone Number	:	845-672-3960
Fax Number	:	845-672-3157

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	LESLIE J GREEN
Credential	:	MD
Telephone Number	:	845-294-5128

Provider Enumeration Date	:	09/02/2014
Last Update Date	:	10/23/2014

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