Healthcare Provider Details

I. General information

NPI: 1972497980
Provider Name (Legal Business Name): FELICIA MARIE CICCO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N CHURCH ST
CARBONDALE PA
18407-1905
US

IV. Provider business mailing address

3319 LAKE ARIEL HWY
HONESDALE PA
18431-1174
US

V. Phone/Fax

Practice location:
  • Phone: 570-282-4080
  • Fax:
Mailing address:
  • Phone: 570-253-6551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG004250
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: