DR. JESSICA LICAUSI (NPI# 1326326224) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326326224 |
| Entity Type | Individual |
| Full Name | DR. JESSICA LICAUSI |
| Other Name | DR. JESSICA FULMER |
| Credential | O.D. |
| Practice Address |
25 Cranberry St Ste A Riverhead NY 11901-2762 |
| Mailing Address |
25 Cranberry St Suite A Riverhead NY 11901-2762 |
| Practice Telephone | 6317409384 |
| Mailing Telephone | 6317409384 |
| Enumeration Date | 2011-07-26 |
| Last Update Date | 2019-08-28 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152W00000X | Optometrist | TUV007703-1 | NY | Eye and Vision Services Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 79 Middleville Rd, Optometry 123, Northport, NY 117682200 | 6312614400 |
| Street Address |
25 CRANBERRY ST STE A |
| City | RIVERHEAD |
| State | NY |
| Zip Code | 11901-2762 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578102786 | Michael Arthur Frangeskos | Physician Assistant | 1330 Roanoke Avenue, Riverhead, NY 11901 | 2020-01-06 |
| 1922569136 | Mjd Optical Corp | Optometrist | 1053 Route 58 Roanoke Ave, Riverhead, NY 11901 | 2019-03-29 |
| 1356837702 | Justin M Liu | Physician Assistant | 31 Main Rd Ste 3, Riverhead, NY 11901 | 2018-07-09 |
| 1467943522 | North Shore Hematology Oncology Associates PC | Clinic/Center | 750 Old Country Rd Bldg 2, Riverhead, NY 11901 | 2018-05-24 |
| 1063918688 | Riverhead Volunteer Ambulance Corps Inc | Ambulance | 111 Osborn Ave, Riverhead, NY 11901 | 2018-04-03 |
| 1669977906 | Joseph Cataldo | Student in an Organized Health Care Education/Training Program | 64 Ida Lane, Riverhead, NY 11901 | 2018-03-28 |
| 1861903056 | The Flanders Northampton Volunteer Ambulance Company Inc | Ambulance | 641 Flanders Road, Flanders, NY 11901 | 2017-10-16 |
| 1336676659 | Patricia Ann Leask | Registered Nurse | 300 Center Drive Suite 250, Methadone Clinic Department of Mental Health, Riverhead, NY 11901 | 2017-05-17 |
| 1922463447 | Diana Williams-burke | Counselor | 550 East Main St Suite 103, Riverhead, NY 11901 | 2015-12-29 |
| 1699155549 | Twin Forks Optometry, Pllc | Optometrist | 25 Cranberry Street, Riverhead, NY 11901 | 2015-06-05 |
| Find all providers in zip 11901 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881221695 | Svc of Riverhead LLC | Optometrist | 887 Old Country Rd Ste Gkl, Riverhead, NY 11901-2115 | 2020-03-24 |
| 1922569136 | Mjd Optical Corp | Optometrist | 1053 Route 58 Roanoke Ave, Riverhead, NY 11901 | 2019-03-29 |
| 1467948299 | Taylor Battaglia | Optometrist | 887 Old Country Rd Ste K-l, Riverhead, NY 11901-2115 | 2018-07-04 |
| 1063852986 | Miki Lyn Zilnicki | Optometrist | 25 Cranberry St, Suite A, Riverhead, NY 11901-2762 | 2013-06-25 |
| 1770784423 | Michael Anthony Algieri | Optometrist | 1053 Old Country Rd, Pearle Vision Center, Riverhead, NY 11901-2019 | 2007-05-30 |
| 1659467587 | Jason Seligman | Optometrist | 765 Old Country Road, Riverhead, NY 11901 | 2006-10-05 |
| 1760463582 | Dean Michael Miller | Optometrist | 1053 Route 58, Riverhead, NY 11901-2019 | 2005-11-09 |
| 1225024490 | Jeffrey Slaney Williams Sr. | Optometrist | 887 Old Country Rd, Suite K-l, Riverhead, NY 11901-2115 | 2005-09-23 |
| 1275143075 | Ava Louise Koch | Optometrist | 887 Old Country Rd Ste G-kl, Riverhead, NY 11901-2115 | 2020-08-06 |
| 1851917256 | Michelle Anne Mckillop | Optometrist | 887 Old Country Rd Ste Gkl, Riverhead, NY 11901-2115 | 2020-06-22 |
| Find all providers in RIVERHEAD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.