=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275507899
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. ASTRID SOPHIA PORQUEDDU
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 HELEN KELLER WAY
-----------------------------------------------------
City | HEMPSTEAD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-485-1234
-----------------------------------------------------
Fax | 516-538-6785
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 42 EAGLE LANE
-----------------------------------------------------
City | LEVITTOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-796-3842
-----------------------------------------------------
Fax | 516-538-6785
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | VUT005767
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------