Organization
REGINA M. DEVITO, O.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REGINA M DEVITO O.D. (OWNER/PRESIDENT)
(315) 440-8168
Entity
Organization
Contact information
Practice address
3949 ROUTE 31, LIVERPOOL, NY 13090
(315) 622-9269
Mailing address
6011 WESTCLIFFE RD, JAMESVILLE, NY 13078-9310
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV005610
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11514877
CAQH#
NY
Enumeration date
07/19/2011
Last updated
07/19/2011
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