Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | TUV0041084 | NY |
NPI | 1003877713 |
---|---|
Provider Name | Dr. Robert Richard Deluccia |
First Address | Syracuse, NY 13224 |
Second Address | Clifton Park, NY 12065 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2006 |
Last Update Date | 07/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U43029 | (02) |