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General NPI Number Information
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NPI Number | 1952300824
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Entity Type | Individual
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Provider Name | DAVID JOHN VINCI OD
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Gender | Male
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Dates
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Enumeration Date | 07/21/2005
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Last Update Date | 09/03/2009
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Provider Practice Location Address
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Address Line | 6 HEADWATERS PLZ ADIRONDACK EYE CARE
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City | BOONVILLE
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State | NY
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Zip | 13309-1300
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Country | US
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Telephone | 315-942-2122
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Fax | 315-942-2084
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Provider Business Mailing Address
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Address Line | 6 HEADWATERS PLZ
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City | BOONVILLE
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State | NY
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Zip | 13309-1300
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Country | US
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Telephone | 315-942-2122
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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 | TUV006918
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License Number State | NY
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