Healthcare Provider Details

I. General information

NPI: 1700882917
Provider Name (Legal Business Name): RICHARD JAMES PICCIONE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4906 AMBASSADOR CAFFERY PKWY STE. 701 BLDG G
LAFAYETTE LA
70508-6916
US

IV. Provider business mailing address

4906 AMBASSADOR CAFFERY PKWY STE. 701 - BLDG G
LAFAYETTE LA
70508-6916
US

V. Phone/Fax

Practice location:
  • Phone: 337-989-2600
  • Fax: 337-989-2601
Mailing address:
  • Phone: 337-989-2600
  • Fax: 337-989-2601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License NumberMD.09888R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD.09888R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: