Individual
DR. LAURA ANN BUCCELLATO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
388 HAWKINS AVE, SUITE 2, RONKONKOMA, NY 11779-4280
(631) 588-7004
(631) 588-2612
Mailing address
388 HAWKINS AVE, SUITE 2, RONKONKOMA, NY 11779-4280
(631) 588-7004
(631) 588-2612
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV6227-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2529608
UNITED HEALTHCARE
NY
01
—
6599232
GHI
NY
01
—
7002866
CIGNA
NY
01
—
C407A1
EMPIRE
NY
01
—
CDWGG1
PTAN MEDICARE
NY
01
—
P3585214
OXFORD
NY
Enumeration date
11/22/2005
Last updated
05/12/2021
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