Physician Compare National (NPI:1912136755)

HEALTHCARE PROVIDER: TIFFANY PROCACCINI O.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1912136755
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4486700762
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20090929000352
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	PROCACCINI
	Individual professional last name
Provider First Name	TIFFANY
	Individual professional first name
Provider Middle Name	L
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OHIO STATE UNIVERSITY - COLLEGE OF OPTOMETRY
	Individual professional's medical school
Graduation Year	2009
	Individual professional's medical school graduation year
Primary Specialty	OPTOMETRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	320 W WALTON
	Group Practice or individual's line 1 address
Line 2 Street Address	PO BOX 270
	Group Practice or individual's line 2 address
City	WILLARD
	Group Practice or individual's city
State	OH
	Group Practice or individual's state
Zip Code	448909133
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y