Provider Demographics
NPI:1578617866
Name:PROSCIA, VITO JR (OD)
Entity Type:Individual
Prefix:DR
First Name:VITO
Middle Name:
Last Name:PROSCIA
Suffix:JR
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 1:126 VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-3019
Mailing Address - Country:US
Mailing Address - Phone:631-361-5391
Mailing Address - Fax:
Practice Address - Street 1:1701 SUNRISE HWY
Practice Address - Street 2:SEARS OPTICAL THIRD FLOOR
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-6091
Practice Address - Country:US
Practice Address - Phone:631-666-5657
Practice Address - Fax:631-666-5657
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYS #VUT005234152W00000X
FLOP 2555152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU31724Medicare UPIN