Provider Demographics
NPI:1871759290
Name:SILHOUETTE EYE STUDIO LLC
Entity type:Organization
Organization Name:SILHOUETTE EYE STUDIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE BILLING/TECHNICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:MINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-944-2300
Mailing Address - Street 1:5 ULENSKI DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1103
Mailing Address - Country:US
Mailing Address - Phone:518-944-2300
Mailing Address - Fax:518-944-2399
Practice Address - Street 1:5 ULENSKI DRIVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205
Practice Address - Country:US
Practice Address - Phone:518-944-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006630152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6149580001Medicare NSC