Basic Information
| Provider Information | |||||||||
| NPI: | 1245208412 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FARUGIA | ||||||||
| FirstName: | THERESE | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 EMPIRE BLVD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | WEBSTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145801957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5856710860 | ||||||||
| FaxNumber: | 5856718549 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 EMPIRE BLVD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | WEBSTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145801957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5856710860 | ||||||||
| FaxNumber: | 5856718549 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 09/27/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 004399-1 | NY | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | PO185221590 | 01 | NY | BLUE CHOICE | OTHER | 5802628 | 01 | NY | AETNA | OTHER | 101964CS | 01 | NY | PREFERRED CARE | OTHER |