John J Maurillo Odpc
Organization Active NPI Optometrist · Skaneateles, NY
NPI 1164601506 · NPPES record last updated Apr 14, 2008
Key facts
- NPI
- 1164601506
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- TUV003192-1 (NY)
- Legal business name
- JOHN J MAURILLO ODPC
- Practice address
- 3986 Jordan Rd
Skaneateles, NY 13152-9401 - Phone
- (315) 685-2020
- Fax
- (315) 685-3337
- NPI assigned
- Nov 2, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. John Joseph Maurillo II, OD
- Title
- Optometrist
- Phone
- (315) 685-2020
Practitioners 6
-
John J Maurillo Jr., O.D.
-
Nancy D. Conley, OPTICIAN
-
Glenn E Stein, OD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071214000368 | NY | Part B Supplier - Clinic/Group Practice | 8325138373 |
Receives reassigned benefits from 1 practitioner Practice locations: Cortland, NY; Skaneateles, NY |
National Provider Directory
Locations
3662 The Park
Cortland, NY 13045
Phone (607) 753-7514
3986 Jordan Rd
Skaneateles, NY 13152
Phone (315) 685-2020
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | TUV003192-1 | NY | Yes |
Addresses
Primary practice location
3986 Jordan Rd
Skaneateles, NY 13152-9401
Mailing address
3986 Jordan Rd
PO Box 0978
Skaneateles, NY 13152-9401
Phone (315) 685-2020
Other names
- dba: village Visions
Other providers in Skaneateles, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 14, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.