Provider Demographics
NPI:1871643130
Name:PACHECO, DORA L (OD)
Entity Type:Individual
Prefix:
First Name:DORA
Middle Name:L
Last Name:PACHECO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:DORA
Other - Middle Name:L
Other - Last Name:PACHECO FRANQUIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31 MEADOW RUE LN
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-4517
Mailing Address - Country:US
Mailing Address - Phone:631-368-9412
Mailing Address - Fax:
Practice Address - Street 1:1701 SUNRISE HWY
Practice Address - Street 2:SOUTH SHORE MALL
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-6091
Practice Address - Country:US
Practice Address - Phone:516-969-9544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT050587152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist