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NPI Code Detail

MEDICARE: TEDESCO OPTICAL, INC.

MEDICARE: TEDESCO OPTICAL, 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
1332B00000XDurable Medical Equipment & Medical Supplies3424NY

General Provider Information

NPI Number : 1356488506
Entity Type Code : Organization
Provider Name (Legal Business Name) : TEDESCO OPTICAL, INC.
Provider Business Mailing Address
First Line : 337 MAMARONECK AVE
Second Line :
City : WHITE PLAINS
State : NY
Zip : 10605-1440
Country : US
Telephone Number : 914-949-0575
Fax Number :
Provider Business Practice Location Address
First Line : 337 MAMARONECK AVE
Second Line :
City : WHITE PLAINS
State : NY
Zip : 10605-1440
Country : US
Telephone Number : 914-949-0575
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : RAFFAELE PETER TEDESCO
Credential : OPTICIAN
Telephone Number : 914-949-0575
Provider Enumeration Date : 01/30/2007
Last Update Date : 05/01/2008

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