MEDICARE: DR. ALICIA DONNA PECCO OD

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	OEG002197	PA

General Provider Information

NPI Number	:	1275764904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALICIA DONNA PECCO OD

Provider Business Mailing Address
First Line	:	2385 W CHELTENHAM AVE STE 312
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19150-1517
Country	:	US
Telephone Number	:	215-887-6538
Fax Number	:	215-887-8748

Provider Business Practice Location Address
First Line	:	2385 W CHELTENHAM AVE STE 312
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19150-1517
Country	:	US
Telephone Number	:	215-887-6538
Fax Number	:	215-887-8748

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

Provider Enumeration Date	:	07/29/2009
Last Update Date	:	06/14/2010

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