Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2724 | MA |
NPI | 1003998527 |
---|---|
Provider Name | Dr. Paul Richard Ciaccio |
First Address | Orleans, MA 02653-9998 |
Second Address | Orleans, MA 02653-9998 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 01/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0335428 | (05) | MA |
0678590001 | DMERC (01) | MA |
T59259 | (02) | MA |
W15423 | BCBS OF MASS (01) | MA |