MEDICARE: DR. TOMMASINA PASQUA SIDERIS OD

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	:	1942297312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TOMMASINA PASQUA SIDERIS OD

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	04/20/2016

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