MEDICARE: MS. VANESSA J. AZZOTO OPTICIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician	008383-1	NY

General Provider Information

NPI Number	:	1023045911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VANESSA J. AZZOTO OPTICIAN

Provider Business Mailing Address
First Line	:	8811 WEDGEFIELD LN
Second Line	:
City	:	CICERO
State	:	NY
Zip	:	13039-9775
Country	:	US
Telephone Number	:	315-698-0576
Fax Number	:

Provider Business Practice Location Address
First Line	:	7903 BREWERTON RD
Second Line	:	WEST MARINE PLAZA
City	:	CICERO
State	:	NY
Zip	:	13039-9531
Country	:	US
Telephone Number	:	315-699-1700
Fax Number	:	315-699-1707

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	10/16/2009

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