Healthcare Provider Details

I. General information

NPI: 1154611283
Provider Name (Legal Business Name): LUCCHETTI TOTAL VISION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 BUFFALO PLAZA
SARVER PA
16055-8302
US

IV. Provider business mailing address

228 BUFFALO PLAZA
SARVER PA
16055-8302
US

V. Phone/Fax

Practice location:
  • Phone: 724-996-5640
  • Fax:
Mailing address:
  • Phone: 724-996-5640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberOEG001016
License Number StatePA

VIII. Authorized Official

Name: VINCENT D LUCCHETTI
Title or Position: OD OWNER
Credential: OD
Phone: 724-996-5640