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General NPI Number Information
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NPI Number | 1598115560
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Entity Type | Individual
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Provider Name | JESSICA LEE DASILVA OD
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Gender | Female
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Dates
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Enumeration Date | 06/20/2016
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Last Update Date | 07/06/2016
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Provider Practice Location Address
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Address Line | 2094 ALBANY POST RD
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City | MONTROSE
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State | NY
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Zip | 10548-1454
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Country | US
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Telephone | 315-398-2201
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Fax |
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Provider Business Mailing Address
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Address Line | 1985 RYDER RD
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City | NEWARK
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State | NY
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Zip | 14513-9335
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Country | US
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Telephone | 315-398-2201
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | TUV008444-1
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License Number State | NY
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