Provider Demographics
NPI:1861471609
Name:LAMONICA, MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:LAMONICA
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 1:500 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-3027
Mailing Address - Country:US
Mailing Address - Phone:631-957-3355
Mailing Address - Fax:631-957-4378
Practice Address - Street 1:500 W MAIN ST
Practice Address - Street 2:#210
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3027
Practice Address - Country:US
Practice Address - Phone:631-957-3355
Practice Address - Fax:631-957-4378
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT005007-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU44766Medicare UPIN