Individual
MR. ROMEO VELASCO MALOCO JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OPTICIAN
Contact information
Practice address
524 JEFFERSON PLZ, PORT JEFFERSON STATION, NY 11776-1104
(631) 476-4707
Mailing address
524 JEFFERSON PLZ, PORT JEFFERSON STATION, NY 11776-1104
(631) 476-4707
Taxonomy
Speciality
Code
Description
License number
State
156FC0801X
Contact Lens Fitter
C006424-1
NY
156FX1800X
Optician
Primary
C006424-1
NY
Other
Enumeration date
04/26/2011
Last updated
04/26/2011
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