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NPI Code Detail

MEDICARE: DEBORILA, INC

MEDICARE: DEBORILA, INC
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
1156FX1800XOptician

General Provider Information

NPI Number : 1265649958
Entity Type Code : Organization
Provider Name (Legal Business Name) : DEBORILA, INC
Provider Business Mailing Address
First Line : 145 MAIN ST
Second Line :
City : SOUTHAMPTON
State : NY
Zip : 11968-4810
Country : US
Telephone Number : 631-283-4244
Fax Number : 631-283-4328
Provider Business Practice Location Address
First Line : 145 MAIN ST
Second Line :
City : SOUTHAMPTON
State : NY
Zip : 11968-4810
Country : US
Telephone Number : 631-283-4244
Fax Number : 631-283-4328
Authorized Official
Title or Position : PARTNER
Name : MS. LAURIE STONE
Credential : OPHTHALMIC DISPENSER
Telephone Number : 631-283-4244
Provider Enumeration Date : 05/16/2007
Last Update Date : 08/22/2020

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Directions to “DEBORILA, INC ” Practice Location

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