Provider Demographics
NPI:1245208412
Name:FARUGIA, THERESE M (OD)
Entity type:Individual
Prefix:DR
First Name:THERESE
Middle Name:M
Last Name:FARUGIA
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 1:2000 EMPIRE BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-1957
Mailing Address - Country:US
Mailing Address - Phone:585-671-0860
Mailing Address - Fax:585-671-8549
Practice Address - Street 1:2000 EMPIRE BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-1957
Practice Address - Country:US
Practice Address - Phone:585-671-0860
Practice Address - Fax:585-671-8549
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4399152W00000X
NY004399-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5802628OtherAETNA
NYPO185221590OtherBLUE CHOICE
NY101964CSOtherPREFERRED CARE
NY101964CSOtherPREFERRED CARE