Provider Demographics
NPI:1366555088
Name:EYE PHYSICIANS & SURGEONS LTD
Entity type:Organization
Organization Name:EYE PHYSICIANS & SURGEONS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIST
Authorized Official - Middle Name:A
Authorized Official - Last Name:BALOURIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-940-4001
Mailing Address - Street 1:7000 STONEWOOD DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-7376
Mailing Address - Country:US
Mailing Address - Phone:724-940-4001
Mailing Address - Fax:724-940-4036
Practice Address - Street 1:7000 STONEWOOD DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-7376
Practice Address - Country:US
Practice Address - Phone:724-940-4001
Practice Address - Fax:724-940-4036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACC5673OtherRAILROAD MEDICARE
PA1366555088Medicare NSC
PA619721Medicare PIN