Healthcare Provider Details

I. General information

NPI: 1184781213
Provider Name (Legal Business Name): VINCENT RICHARD VICCI JR. OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2007
Last Update Date: 04/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

592 SPRINGFIELD AVE
WESTFIELD NJ
07090-1002
US

IV. Provider business mailing address

592 SPRINGFIELD AVE
WESTFIELD NJ
07090-1002
US

V. Phone/Fax

Practice location:
  • Phone: 908-654-7950
  • Fax: 908-654-7956
Mailing address:
  • Phone: 908-654-7950
  • Fax: 908-654-7956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number27OA00416900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number27OA00416900
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number27OA00416900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: