Michelle L Damico
Individual provider Active NPI Optician · Brockport, NY
NPI 1093380768 · NPPES record last updated May 25, 2021
Key facts
- NPI
- 1093380768
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optician 156FX1800X
- License
- 006131-01 (NY)
- Practice address
- 300 West Ave
Brockport, NY 14420-1118 - Phone
- (585) 637-3905
- NPI assigned
- May 25, 2021
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 006131-01 | NY | MD | Optician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician |
156FX1800X | 006131-01 | NY | Yes |
Addresses
Primary practice location
300 West Ave
Brockport, NY 14420-1118
Mailing address
8181 Sackett Rd
Bergen, NY 14416-9350
Phone (585) 301-1746
Other providers in Brockport, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 25, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.