Individual
DR. SANDRA JEAN TARASEVICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
340 ROUTE 202, BLDG A, 2ND FLOOR - MAILBOX #7, SOMERS, NY 10589-3207
(914) 669-9144
(914) 669-1035
Mailing address
340 ROUTE 202, BLDG A, 2ND FLOOR - MAILBOX #7, SOMERS, NY 10589-3207
(914) 669-9144
(914) 669-1035
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
T005613
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007934
CONNECTICARE ID
NY
01
—
4C1816
HEALTHNET ID
NY
01
—
597225
MVP ID
NY
01
—
6599675
GHI ID
NY
01
—
7636057
AETNA ID
NY
01
—
C1T481
BCBS ID
NY
01
—
P1961894
OXFORD ID
NY
Enumeration date
01/21/2006
Last updated
02/20/2014
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