Healthcare Provider Details

I. General information

NPI: 1215993050
Provider Name (Legal Business Name): PAULA NUTIS-FINNERAN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PAULA NUTIS-FINNERAN OD

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 SMITH HAVEN MALL
LAKE GROVE NY
11755-1219
US

IV. Provider business mailing address

2 SMITH HAVEN MALL
LAKE GROVE NY
11755-1219
US

V. Phone/Fax

Practice location:
  • Phone: 631-360-2108
  • Fax: 631-360-2045
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV006915
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV006915-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: