Provider Demographics
NPI:1861582041
Name:BINGHAMTON OPHTHALMOLOGY ASSOCIATES, P.C.
Entity type:Organization
Organization Name:BINGHAMTON OPHTHALMOLOGY ASSOCIATES, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-723-7586
Mailing Address - Street 1:33 MITCHELL AVENUE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13903
Mailing Address - Country:US
Mailing Address - Phone:607-723-7586
Mailing Address - Fax:607-723-1989
Practice Address - Street 1:33 MITCHELL AVENUE
Practice Address - Street 2:SUITE 207
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903
Practice Address - Country:US
Practice Address - Phone:607-723-7586
Practice Address - Fax:607-723-1989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0067631152W00000X
NYTUV0067171152W00000X
NY4799332H00000X
NY2474661207W00000X
NY120268207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02061489Medicaid
NY02061489Medicaid
NY0416240001Medicare NSC