Provider Demographics
NPI:1003877713
Name:DELUCCIA, ROBERT RICHARD (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:RICHARD
Last Name:DELUCCIA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2921 ERIE BLVD EAST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224
Mailing Address - Country:US
Mailing Address - Phone:315-445-7465
Mailing Address - Fax:315-445-7675
Practice Address - Street 1:54 THE CROSSINGS SUITES K &Y
Practice Address - Street 2:EMPIRE VISION CENTERS
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065
Practice Address - Country:US
Practice Address - Phone:518-373-2200
Practice Address - Fax:518-373-2350
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0041084152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC0636Medicare ID - Type Unspecified
NYRB0311Medicare PIN
NYRB0313Medicare PIN
NYRB0312Medicare PIN
U43029Medicare UPIN