MEDICARE: JOHN J MAURILLO ODPC

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	152W00000X	Optometrist	TUV003192-1	NY

General Provider Information

NPI Number	:	1164601506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN J MAURILLO ODPC

Provider Business Mailing Address
First Line	:	3986 JORDAN RD
Second Line	:	PO BOX 0978
City	:	SKANEATELES
State	:	NY
Zip	:	13152-9401
Country	:	US
Telephone Number	:	315-685-2020
Fax Number	:	315-685-3337

Provider Business Practice Location Address
First Line	:	3986 JORDAN RD
Second Line	:
City	:	SKANEATELES
State	:	NY
Zip	:	13152-9401
Country	:	US
Telephone Number	:	315-685-2020
Fax Number	:	315-685-3337

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. JOHN JOSEPH MAURILLO II
Credential	:	OD
Telephone Number	:	315-685-2020

Provider Enumeration Date	:	11/02/2007
Last Update Date	:	04/14/2008

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