Provider Demographics
NPI:1447583372
Name:VIGARIO, TERESA J (OD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:J
Last Name:VIGARIO
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 1:405 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-3140
Mailing Address - Country:US
Mailing Address - Phone:973-465-0571
Mailing Address - Fax:
Practice Address - Street 1:651 KAPKOWSKI RD
Practice Address - Street 2:SUITE 1236
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201-4901
Practice Address - Country:US
Practice Address - Phone:908-354-1599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA0062O500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist