MEDICARE: TOMMASINA ENTERPRISES, LLC

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	2930	CT

General Provider Information

NPI Number	:	1295180339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOMMASINA ENTERPRISES, LLC

Provider Business Mailing Address
First Line	:	17C COMMONS DR
Second Line	:
City	:	LITCHFIELD
State	:	CT
Zip	:	06759-3448
Country	:	US
Telephone Number	:	860-880-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	17C COMMONS DR
Second Line	:
City	:	LITCHFIELD
State	:	CT
Zip	:	06759-3448
Country	:	US
Telephone Number	:	860-880-2020
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TOMMASINA PASQUA SIDERIS
Credential	:	OD
Telephone Number	:	860-880-2020

Provider Enumeration Date	:	04/26/2016
Last Update Date	:	04/26/2016

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