MEDICARE: DR. GINO J BIANCONI 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	OEG003485	PA
2	152W00000X	Optometrist	0618002712	VA

General Provider Information

NPI Number	:	1386129252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GINO J BIANCONI OD

Provider Business Mailing Address
First Line	:	3712 VIRGINIA BEACH BLVD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-3414
Country	:	US
Telephone Number	:	757-463-3576
Fax Number	:

Provider Business Practice Location Address
First Line	:	236 CARMICHAEL WAY STE 318
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23322-2185
Country	:	US
Telephone Number	:	757-255-1330
Fax Number	:

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

Provider Enumeration Date	:	09/26/2018
Last Update Date	:	01/10/2020

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