Provider Demographics
NPI:1043391881
Name:CALABRESE, THEODORE J (OD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:J
Last Name:CALABRESE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 COUNTY ROAD 39A
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-5257
Mailing Address - Country:US
Mailing Address - Phone:631-283-6226
Mailing Address - Fax:631-283-6226
Practice Address - Street 1:414 COUNTY ROAD 39A
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-5257
Practice Address - Country:US
Practice Address - Phone:631-283-6226
Practice Address - Fax:631-283-6226
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV5211152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300001017Medicare PIN
NYC00121Medicare ID - Type Unspecified