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General NPI Number Information
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NPI Number | 1881861003
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Entity Type | Individual
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Provider Name | ELVIRO EGISTO LAROCCA OPTICIAN
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Gender | Male
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Dates
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Enumeration Date | 05/15/2008
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Last Update Date | 05/15/2008
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Provider Practice Location Address
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Address Line | 379 PARK AVE
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City | ROCHESTER
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State | NY
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Zip | 14607-2807
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Country | US
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Telephone | 585-705-0974
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Fax |
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Provider Business Mailing Address
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Address Line | 1 PLEASANT ST APT# 502
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City | ROCHESTER
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State | NY
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Zip | 14604-1455
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Country | US
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Telephone | 585-705-0974
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number | 008610-1
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License Number State | NY
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