Provider Demographics
NPI:1750940854
Name:PICCOLE, ALAN ROBERT
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:ROBERT
Last Name:PICCOLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01904-2717
Mailing Address - Country:US
Mailing Address - Phone:781-592-8419
Mailing Address - Fax:781-598-1121
Practice Address - Street 1:518 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01904-2717
Practice Address - Country:US
Practice Address - Phone:781-592-8419
Practice Address - Fax:781-598-1121
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1941156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician