Provider Demographics
NPI:1215993050
Name:NUTIS-FINNERAN, PAULA (OD)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:
Last Name:NUTIS-FINNERAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:PAULA
Other - Middle Name:
Other - Last Name:NUTIS-FINNERAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:2 SMITH HAVEN MALL
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-1219
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 SMITH HAVEN MALL
Practice Address - Street 2:
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755-1219
Practice Address - Country:US
Practice Address - Phone:631-360-2108
Practice Address - Fax:631-360-2045
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006915152W00000X
NYTUV006915-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V07426Medicare UPIN
NYC425D1Medicare ID - Type Unspecified