Provider Demographics
NPI:1720162431
Name:BACARIS, THERESA LOSCALZO (OD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:LOSCALZO
Last Name:BACARIS
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 1:1360 MONTAUK HWY
Mailing Address - Street 2:STE 2E
Mailing Address - City:MASTIC
Mailing Address - State:NY
Mailing Address - Zip Code:11950-2929
Mailing Address - Country:US
Mailing Address - Phone:631-281-2474
Mailing Address - Fax:631-281-2476
Practice Address - Street 1:1360 MONTAUK HWY
Practice Address - Street 2:STE 2E
Practice Address - City:MASTIC
Practice Address - State:NY
Practice Address - Zip Code:11950-2929
Practice Address - Country:US
Practice Address - Phone:631-281-2474
Practice Address - Fax:631-281-2476
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT004799-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY26993OtherSPECTERA
NY34416OtherAVESIS
NY201972162OtherNVA
NY2136929OtherVYTRA
NY201972162OtherCOMP BENEFITS
NY201972162OtherHORIZON HEALTHCARE
NY6599195OtherGHI
NY921377OtherBLOCK VISION
NYNY0047OtherEYEMED
NY198546POtherHIP
NY201972162OtherISLAND GROUP ADMINISTATOR
NYP3548978OtherOXFORD
NY34416OtherAVESIS