Provider Demographics
NPI:1942261458
Name:CATUNTO, DESIDERIO M (OD)
Entity type:Individual
Prefix:DR
First Name:DESIDERIO
Middle Name:M
Last Name:CATUNTO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5399 W GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-2265
Mailing Address - Country:US
Mailing Address - Phone:315-468-2745
Mailing Address - Fax:315-468-2786
Practice Address - Street 1:5399 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-2265
Practice Address - Country:US
Practice Address - Phone:315-468-2745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-01
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT0058581152W00000X
NYRT005858-01152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U74706Medicare UPIN
NYCC7195Medicare ID - Type Unspecified