Provider Demographics
NPI:1023241437
Name:VRICELLA, VITO (OD)
Entity type:Individual
Prefix:DR
First Name:VITO
Middle Name:
Last Name:VRICELLA
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 1:1391 SMIZER MILL RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-7306
Mailing Address - Country:US
Mailing Address - Phone:636-305-9600
Mailing Address - Fax:
Practice Address - Street 1:1391 SMIZER MILL RD
Practice Address - Street 2:SUITE 102
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-7306
Practice Address - Country:US
Practice Address - Phone:636-305-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010020480152W00000X
IL046.010363152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist