Provider Demographics
NPI:1790291532
Name:SEECHARAN, ANGELICCA TRISHA (LICENSED OPTICIAN)
Entity Type:Individual
Prefix:MS
First Name:ANGELICCA
Middle Name:TRISHA
Last Name:SEECHARAN
Suffix:
Gender:F
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 CROOKED HILL RD
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-5407
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:85 CROOKED HILL RD
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5407
Practice Address - Country:US
Practice Address - Phone:631-864-1975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-15
Last Update Date:2018-01-23
Deactivation Date:2017-12-16
Deactivation Code:
Reactivation Date:2018-01-23
Provider Licenses
StateLicense IDTaxonomies
NY008796-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician