MEDICARE: DR. MICHAEL A SACCUCCI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	ODTG00477	RI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	410033599	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	720117301	OTHER		CIGNA
2	050369447	OTHER		VISION SERVICE PLAN
3	2200163	OTHER	RI	UNITED HEALTHCARE
4	2847	OTHER		NEIGHBORHOOD HEALTH
5	001976	OTHER		BLUE CHIP
6	0550481	OTHER		AETNA HMO
7	7389920002	OTHER		CIGNA PAL #
9	5714177	OTHER		AETNA NON HMO
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	324	OTHER	RI	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1265486526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL A SACCUCCI MD

Provider Business Mailing Address
First Line	:	55 VILLAGE SQUARE DR
Second Line	:
City	:	SOUTH KINGSTOWN
State	:	RI
Zip	:	02879-8274
Country	:	US
Telephone Number	:	401-272-2020
Fax Number	:	401-789-4113

Provider Business Practice Location Address
First Line	:	55 VILLAGE SQUARE DR
Second Line	:
City	:	SOUTH KINGSTOWN
State	:	RI
Zip	:	02879-8274
Country	:	US
Telephone Number	:	401-272-2020
Fax Number	:	401-789-4113

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	02/17/2015

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Directions to “ DR. MICHAEL A SACCUCCI MD” Practice Location

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