OrganizationTri State Eye Ophthalmology Of Middletown Pc(<Unavail>)SpecialistOther Service ProvidersPractice Address75 Crystal Run Rd, Suite 120, Middletown, NY 10941-7000(845) 703-2020PECOS EnrollmentBased on the most recent information from CMS, provider Tri State Eye Ophthalmology Of Middletown Pc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1053430256Provider TypeOrganizationFull NameTri State Eye Ophthalmology Of Middletown PcOther Name<Unavail>SubpartNoEnumeration Date3/28/2007Last Updated1/30/2015Contact InformationPractice LocationPractice Address75 Crystal Run Rd, Suite 120, Middletown, NY 10941-7000Phone(845) 703-2020Fax(845) 703-2901Mailing LocationMailing Address75 Crystal Run Rd, Suite 120, Middletown, NY 10941-7000Phone(845) 703-2020Fax(845) 703-2901Authorized OfficialNamePalydowycz, Severin Bohdan (Owner)Phone(570) 296-9696Provider TaxonomiesCodeDescriptionLicenseCode174400000XPrimaryDescriptionSpecialistOther Service ProvidersLicenseMD049303LNew York