Provider Demographics
NPI:1497706568
Name:VERRONE, JUSTIN JOSEPH (OD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:JOSEPH
Last Name:VERRONE
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 1:2142 PENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526
Mailing Address - Country:US
Mailing Address - Phone:585-377-7090
Mailing Address - Fax:585-377-3155
Practice Address - Street 1:2142 PENFIELD RD
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526
Practice Address - Country:US
Practice Address - Phone:585-377-7090
Practice Address - Fax:585-377-3155
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT006260152W00000X
NYTUV006260152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7432127OtherAETNA
NYP010106260OtherBLUE SHIELD
NYP010006260OtherDOCTORS HEALTH
NY106339CSOtherPREFERRED CARE
NY1568685113OtherMEDICARE NSC
NY161274164OtherHEALTH NOW
NY161274164OtherUNITED HEALTH
NYP010006260OtherBLUE CHOICE
NY7432127OtherAETNA
NY161274164OtherUNITED HEALTH
NYDD0607Medicare ID - Type Unspecified