Provider Demographics
NPI:1164601506
Name:JOHN J MAURILLO ODPC
Entity Type:Organization
Organization Name:JOHN J MAURILLO ODPC
Other - Org Name:DBA: VILLAGE VISIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MAURILLO
Authorized Official - Suffix:II
Authorized Official - Credentials:OD
Authorized Official - Phone:315-685-2020
Mailing Address - Street 1:3986 JORDAN RD
Mailing Address - Street 2:PO BOX 0978
Mailing Address - City:SKANEATELES
Mailing Address - State:NY
Mailing Address - Zip Code:13152-9401
Mailing Address - Country:US
Mailing Address - Phone:315-685-2020
Mailing Address - Fax:315-685-3337
Practice Address - Street 1:3986 JORDAN RD
Practice Address - Street 2:
Practice Address - City:SKANEATELES
Practice Address - State:NY
Practice Address - Zip Code:13152-9401
Practice Address - Country:US
Practice Address - Phone:315-685-2020
Practice Address - Fax:315-685-3337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003192-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT26447Medicare UPIN
NY0640400001Medicare NSC
NYAA1160Medicare PIN