Provider Demographics
NPI:1861838575
Name:MATEO, FELICIA I (OPTICIAN)
Entity Type:Individual
Prefix:PROF
First Name:FELICIA
Middle Name:
Last Name:MATEO
Suffix:I
Gender:F
Credentials:OPTICIAN
Other - Prefix:MRS
Other - First Name:FELICIA
Other - Middle Name:
Other - Last Name:MATEO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2524 RADCLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-4206
Mailing Address - Country:US
Mailing Address - Phone:347-874-9876
Mailing Address - Fax:
Practice Address - Street 1:2524 RADCLIFF AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-4206
Practice Address - Country:US
Practice Address - Phone:347-874-9876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008360-1156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic