Provider Demographics
NPI:1295921468
Name:SEMIOLI, JOHN ROBERT (OPTICIAN)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
Last Name:SEMIOLI
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4315
Mailing Address - Country:US
Mailing Address - Phone:718-832-5889
Mailing Address - Fax:718-832-5890
Practice Address - Street 1:364 7TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4315
Practice Address - Country:US
Practice Address - Phone:718-832-5889
Practice Address - Fax:718-832-5890
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3548156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY087634001Medicare PIN
NY0876340001Medicare NSC