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General NPI Number Information
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NPI Number | 1306626098
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Entity Type | Organization
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Legal Business Name | SOUTHAMPTON OPTIKS LTD
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Dates
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Enumeration Date | 10/02/2023
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Last Update Date | 10/02/2023
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Provider Practice Location Address
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Address Line | 414 COUNTY ROAD 39A
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City | SOUTHAMPTON
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State | NY
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Zip | 11968-5257
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Country | US
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Telephone | 631-283-6226
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Fax | 631-287-2946
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Provider Business Mailing Address
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Address Line | 414 COUNTY ROAD 39A
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City | SOUTHAMPTON
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State | NY
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Zip | 11968-5257
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Country | US
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Telephone | 631-283-6226
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Fax | 631-287-2946
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. THEODORE J CALABRESE JR.
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Credential | OD
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Telephone | 631-283-6226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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