Provider Demographics
NPI:1003931486
Name:DEPROSPO, JOHN T (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:T
Last Name:DEPROSPO
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:314 LIVINGSTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-1033
Mailing Address - Country:US
Mailing Address - Phone:718-875-3351
Mailing Address - Fax:718-875-5687
Practice Address - Street 1:314 LIVINGSTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-1033
Practice Address - Country:US
Practice Address - Phone:718-875-3351
Practice Address - Fax:718-875-5687
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006048156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician