Healthcare Provider Details

I. General information

NPI: 1699777078
Provider Name (Legal Business Name): KAY R. RICCIOTTI O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 05/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 MERRIAM AVE SUITE 121
LEOMINSTER MA
01453
US

IV. Provider business mailing address

865 MERRIAM AVE SUITE 121
LEOMINSTER MA
01453
US

V. Phone/Fax

Practice location:
  • Phone: 978-537-6045
  • Fax: 978-534-9845
Mailing address:
  • Phone: 978-537-6045
  • Fax: 978-534-9845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4215
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: