Provider Demographics
NPI:1043212822
Name:PANZONE, REGINA F (OD)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:F
Last Name:PANZONE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8211 STATE ROUTE 28
Mailing Address - Street 2:
Mailing Address - City:BARNEVELD
Mailing Address - State:NY
Mailing Address - Zip Code:13304-2109
Mailing Address - Country:US
Mailing Address - Phone:315-896-2971
Mailing Address - Fax:
Practice Address - Street 1:110 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-2832
Practice Address - Country:US
Practice Address - Phone:315-336-8370
Practice Address - Fax:315-339-0612
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0051061152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01563217Medicaid
NY55917BMedicare PIN
U09737Medicare UPIN