Provider Demographics
NPI:1740361948
Name:DEVITO, REGINA MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:REGINA
Middle Name:MARIE
Last Name:DEVITO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6011 WESTCLIFFE RD
Mailing Address - Street 2:
Mailing Address - City:JAMESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13078-9310
Mailing Address - Country:US
Mailing Address - Phone:315-446-1685
Mailing Address - Fax:315-446-1685
Practice Address - Street 1:3949 RT. 31
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090
Practice Address - Country:US
Practice Address - Phone:315-622-9269
Practice Address - Fax:315-622-3715
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005610152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9681598OtherMVP HEALTHCARE
NY000132379OtherBLUECROSS/BLUESHEILD
NY9681598OtherMVP HEALTHCARE