Healthcare Provider Details

I. General information

NPI: 1053449868
Provider Name (Legal Business Name): JOHN TRANCHESE OPTICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 ROXBURY DR
COMMACK NY
11725-1324
US

IV. Provider business mailing address

11 ROXBURY DR
COMMACK NY
11725-1324
US

V. Phone/Fax

Practice location:
  • Phone: 631-543-8732
  • Fax: 631-543-8010
Mailing address:
  • Phone: 631-543-8732
  • Fax: 631-543-8010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberC4340
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: