Provider Demographics
NPI:1114000932
Name:VOTA, LAURA SUSAN
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:SUSAN
Last Name:VOTA
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:SUSAN
Other - Last Name:DANIELS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:199 MERRITTS RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-3246
Mailing Address - Country:US
Mailing Address - Phone:516-420-9595
Mailing Address - Fax:
Practice Address - Street 1:199 MERRITTS RD
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-3246
Practice Address - Country:US
Practice Address - Phone:516-420-9595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005739152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist