Provider Demographics
NPI:1295934651
Name:VINCENT R. VICCI, JR. O.D., P.A.
Entity type:Organization
Organization Name:VINCENT R. VICCI, JR. O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:VICCI
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:908-654-7950
Mailing Address - Street 1:592 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-1002
Mailing Address - Country:US
Mailing Address - Phone:908-654-7950
Mailing Address - Fax:908-654-7956
Practice Address - Street 1:592 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-1002
Practice Address - Country:US
Practice Address - Phone:908-654-7950
Practice Address - Fax:908-654-7956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00416900152WP0200X, 152WV0400X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ093938OtherMEDICARE GROUP #