MEDICARE: DR. THERESE M FARUGIA O.D.

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	4399	NY
2	152W00000X	Optometrist	004399-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5802628	OTHER	NY	AETNA
2	PO185221590	OTHER	NY	BLUE CHOICE
3	101964CS	OTHER	NY	PREFERRED CARE

General Provider Information

NPI Number	:	1245208412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THERESE M FARUGIA O.D.

Provider Business Mailing Address
First Line	:	2000 EMPIRE BLVD
Second Line	:	SUITE 110
City	:	WEBSTER
State	:	NY
Zip	:	14580-1957
Country	:	US
Telephone Number	:	585-671-0860
Fax Number	:	585-671-8549

Provider Business Practice Location Address
First Line	:	2000 EMPIRE BLVD
Second Line	:	SUITE 110
City	:	WEBSTER
State	:	NY
Zip	:	14580-1957
Country	:	US
Telephone Number	:	585-671-0860
Fax Number	:	585-671-8549

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	06/30/2023

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