Provider Demographics
NPI:1053449868
Name:TRANCHESE, JOHN (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:TRANCHESE
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 ROXBURY DR
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-1324
Mailing Address - Country:US
Mailing Address - Phone:631-543-8732
Mailing Address - Fax:631-543-8010
Practice Address - Street 1:11 ROXBURY DR
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-1324
Practice Address - Country:US
Practice Address - Phone:631-543-8732
Practice Address - Fax:631-543-8010
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC4340156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01459847Medicaid