Provider Demographics
NPI:1639417751
Name:WOLFISH, CARA SUSAN (OD)
Entity Type:Individual
Prefix:DR
First Name:CARA
Middle Name:SUSAN
Last Name:WOLFISH
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 1:309-313 MERRICK ROAD
Mailing Address - Street 2:#3
Mailing Address - City:ROCKVILLE CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:11570-5325
Mailing Address - Country:US
Mailing Address - Phone:516-536-1031
Mailing Address - Fax:
Practice Address - Street 1:309-313 MERRICK ROAD
Practice Address - Street 2:#3
Practice Address - City:ROCKVILLE CENTER
Practice Address - State:NY
Practice Address - Zip Code:11570-5325
Practice Address - Country:US
Practice Address - Phone:516-536-1031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007931152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist