MEDICARE: DR. JOHN J MAURILLO JR. O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TUV003192-1	NY

General Provider Information

NPI Number	:	1558353599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN J MAURILLO JR. O.D.

Provider Business Mailing Address
First Line	:	3986 JORDAN RD
Second Line	:
City	:	SKANEATELES
State	:	NY
Zip	:	13152-9401
Country	:	US
Telephone Number	:	315-685-2020
Fax Number	:	315-685-3337

Provider Business Practice Location Address
First Line	:	3986 JORDAN RD
Second Line	:	SUITE A
City	:	SKANEATELES
State	:	NY
Zip	:	13152-9401
Country	:	US
Telephone Number	:	315-685-2020
Fax Number	:	315-685-3337

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	04/23/2012

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