Individual
DR. JESSICA LICAUSI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
25 CRANBERRY ST STE A, RIVERHEAD, NY 11901-2762
(631) 740-9384
Mailing address
25 CRANBERRY ST, SUITE A, RIVERHEAD, NY 11901-2762
(631) 740-9384
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV007703-1
NY
Other
Enumeration date
07/26/2011
Last updated
08/28/2019
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