Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | TA 1018 | MD |
NPI | 1265570014 |
---|---|
Provider Name | Dr. Vincente Mario Simoncini |
First Address | Annapolis, MD 21401-3404 |
Second Address | Annapolis, MD 21401-3404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2007 |
Last Update Date | 18/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P01378665 | RAILROAD MEDICARE (01) | MD |
U46673 | (02) | MD |