Individual
DR. JOHN A FACCHIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
111 GRAND AVENUE, MASSAPEQUA, NY 11758
(516) 798-2635
(516) 798-0896
Mailing address
111 GRAND AVENUE, MASSAPEQUA, NY 11758
(516) 798-2635
(516) 798-0896
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV0052761
NY
152WV0400X
Vision Therapy Optometrist
TUV0052761
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01474419
—
NY
Enumeration date
04/19/2006
Last updated
03/20/2008
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