Provider Demographics
NPI:1679391163
Name:AGUIRRE, ERIKA JAZMIN
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:JAZMIN
Last Name:AGUIRRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3990 NESCONSET HWY
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3334
Mailing Address - Country:US
Mailing Address - Phone:631-474-3808
Mailing Address - Fax:631-474-3815
Practice Address - Street 1:3990 NESCONSET HWY
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3334
Practice Address - Country:US
Practice Address - Phone:631-474-3808
Practice Address - Fax:631-474-3815
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2407833156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician