Provider Demographics
NPI:1811532823
Name:VARGHESE, TRESSA (OD)
Entity type:Individual
Prefix:DR
First Name:TRESSA
Middle Name:
Last Name:VARGHESE
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 1:26207 86TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-1122
Mailing Address - Country:US
Mailing Address - Phone:347-754-2121
Mailing Address - Fax:
Practice Address - Street 1:630 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-3467
Practice Address - Country:US
Practice Address - Phone:516-294-0011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-13
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009078152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist