Healthcare Provider Details

I. General information

NPI: 1669517918
Provider Name (Legal Business Name): TAMI DAWN LAPP OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

937 E MAIN ST
RIVERHEAD NY
11901-2564
US

IV. Provider business mailing address

2800 MARCUS AVE
NEW HYDE PARK NY
11042-1113
US

V. Phone/Fax

Practice location:
  • Phone: 631-369-0777
  • Fax: 631-369-0976
Mailing address:
  • Phone: 516-622-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV005768
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: