Healthcare Provider Details

I. General information

NPI: 1497842850
Provider Name (Legal Business Name): ROBERT DANIEL TRICARICO OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3586 RT 22 W
WHITEHOUSE STATION NJ
08889
US

IV. Provider business mailing address

PO BOX 464 3586 RT 22 W
WHITEHOUSE STATION NJ
08889
US

V. Phone/Fax

Practice location:
  • Phone: 908-534-9892
  • Fax: 908-534-2482
Mailing address:
  • Phone: 908-534-9892
  • Fax: 908-534-2482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00377400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: