Healthcare Provider Details

I. General information

NPI: 1801886874
Provider Name (Legal Business Name): DREW A RICCHIUTI O D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 04/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 S LINCOLN AVE EYE ASSOCIATES
VINELAND NJ
08361-7802
US

IV. Provider business mailing address

251 S LINCOLN AVE EYE ASSOCIATES
VINELAND NJ
08361-7802
US

V. Phone/Fax

Practice location:
  • Phone: 856-691-8188
  • Fax:
Mailing address:
  • Phone: 856-691-8188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOA00573000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: