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General NPI Number Information
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NPI Number | 1073540126
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Entity Type | Individual
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Provider Name | PAUL J VACCARELLA O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 12/12/2009
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Provider Practice Location Address
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Address Line | 301 MOUNT HOPE AVE SUITE 2002
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City | ROCKAWAY
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State | NJ
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Zip | 07866-2130
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Country | US
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Telephone | 973-366-9622
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Fax |
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Provider Business Mailing Address
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Address Line | 12 SHADOW HILL WAY
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City | HACKETTSTOWN
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State | NJ
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Zip | 07840-5672
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Country | US
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Telephone | 908-979-1183
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OA00512900
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License Number State | NJ
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