Provider Demographics
NPI:1164558680
Name:PARLATO, SANDY M (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:SANDY
Middle Name:M
Last Name:PARLATO
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 1:4404 DEWEY AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14616
Mailing Address - Country:US
Mailing Address - Phone:585-663-4320
Mailing Address - Fax:585-663-4359
Practice Address - Street 1:4404 DEWEY AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616
Practice Address - Country:US
Practice Address - Phone:585-663-4320
Practice Address - Fax:585-663-4359
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC003162152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P017813059OtherBLUE CROSS BLUE SHIELD
103286CTOtherPREFERRED CARE
0830560001Medicare ID - Type Unspecified