MEDICARE: DOWNSTATE OPHTHALMOLOGY ASSOCIATES, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821042664
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOWNSTATE OPHTHALMOLOGY ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	11 PLAZA ST W
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-3706
Country	:	US
Telephone Number	:	718-638-2020
Fax Number	:	718-230-3429

Provider Business Practice Location Address
First Line	:	11 PLAZA ST W
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-3706
Country	:	US
Telephone Number	:	718-638-2020
Fax Number	:	718-230-3429

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. EDWARD FRED SMITH
Credential	:	M.D.
Telephone Number	:	718-638-2020

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	08/22/2020

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