Organization Active NPI

Retina-Vitreous Surgeons of Central New York, PC

  • Retina Specialist (Ophthalmology) Physician
  • Liverpool, NY
National Provider Identifier
1124012737
Registry record updated Dec 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X
Legal business name
RETINA-VITREOUS SURGEONS OF CENTRAL NEW YORK, PC
Practice address
200 Greenfield Pkwy
Liverpool, NY 13088-6655
Phone
(315) 445-8166
Fax
(315) 445-2697
NPI assigned
Sep 9, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Anne Smith
Title
Business Services Coordinator
Phone
(315) 445-8166

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Retina Specialist (Ophthalmology) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207WX0107X Primary

Addresses

Primary practice location

200 Greenfield Pkwy
Liverpool, NY 13088-6655

Mailing address

200 Greenfield Pkwy
Liverpool, NY 13088-6655
Phone (315) 445-8166

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040710000198 NY Part B Supplier - Clinic/Group Practice 4385622927 Receives reassigned benefits from 8 practitioners
Practice locations: Ithaca, NY; Liverpool, NY; New Hartford, NY; Vestal, NY; Watertown, NY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D2029975Retina-Vitreous Surgeons of Central Ny, PC200 Greenfield Parkway, Liverpool, NY 13088Certificate of waiverSep 19, 2027

National Provider Directory

National Provider Directory

Locations

821 Cliff St
#6
Ithaca, NY 14850
Phone (315) 445-8166

821 Cliff St
Ste 6
Ithaca, NY 14850

200 Greenfield Pkwy
Liverpool, NY 13088
Phone (315) 445-8166

555 French Rd
Bldg 1
New Hartford, NY 13413
Phone (315) 798-9100

4104 Vestal Rd
Ste 103
Vestal, NY 13850
Phone (315) 445-8166

400 Washington St
Watertown, NY 13601
Phone (315) 782-0492

22708 Summit Dr
Ste 1
Watertown, NY 13601
Phone (315) 445-8166

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734652800000",
    "number": "1124012737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 GREENFIELD PKWY",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130886655",
            "telephone_number": "315-445-8166",
            "fax_number": "315-445-2697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 GREENFIELD PKWY",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130886655",
            "telephone_number": "315-445-8166",
            "fax_number": "315-445-2697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RETINA-VITREOUS SURGEONS OF CENTRAL NEW YORK, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-09",
        "last_updated": "2024-12-20",
        "certification_date": "2024-12-20",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "ANNE",
        "authorized_official_title_or_position": "BUSINESS SERVICES COORDINATOR",
        "authorized_official_telephone_number": "315-445-8166",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207WX0107X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology, Retina Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Liverpool, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.