Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 4901002831 | MI |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 4901002831 | MI |
N | 152WP0200X | Pediatric Optomitrist | 4901002831 | MI |
N | 152WS0006X | Sports Vision | 4901002831 | MI |
NPI | 1043380553 |
---|---|
Provider Name | Dr. Angelo Tocco |
First Address | Grosse Pointe, MI 48236-1456 |
Second Address | Grosse Pointe, MI 48236-1456 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2006 |
Last Update Date | 09/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
382191872 | (05) | MI |
U11413 | (02) | MI |