Healthcare Provider Details

I. General information

NPI: 1548350358
Provider Name (Legal Business Name): FRANK EDMUND VISCO JR. O.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1284 DRYDEN RD
ITHACA NY
14850-8795
US

IV. Provider business mailing address

3534 STATE ROUTE 215
CORTLAND NY
13045-9440
US

V. Phone/Fax

Practice location:
  • Phone: 607-257-1066
  • Fax: 607-257-1378
Mailing address:
  • Phone: 832-264-9571
  • Fax: 607-257-1378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberTUV007249
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: