Provider Demographics
NPI:1770587727
Name:DAUS, THERESA SOLASKI (OD)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:SOLASKI
Last Name:DAUS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:JEAN
Other - Last Name:SOLASKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:360 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4403
Mailing Address - Country:US
Mailing Address - Phone:631-422-1110
Mailing Address - Fax:
Practice Address - Street 1:360 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4403
Practice Address - Country:US
Practice Address - Phone:631-422-1110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1461152W00000X
VA0618002137152W00000X
NY005592152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD54725501OtherCAREFIRST
MD10036579OtherMEDICARE RR PIN
DC8185-0004OtherCAREFIRST
MDKN29716UMedicare PIN
MD10036579OtherMEDICARE RR PIN