Provider Demographics
NPI:1003998527
Name:CIACCIO, PAUL RICHARD (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:RICHARD
Last Name:CIACCIO
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 1:56 MAIN ST
Mailing Address - Street 2:PO BOX 1331
Mailing Address - City:ORLEANS
Mailing Address - State:MA
Mailing Address - Zip Code:02653-9998
Mailing Address - Country:US
Mailing Address - Phone:508-255-0444
Mailing Address - Fax:
Practice Address - Street 1:56 MAIN ST
Practice Address - Street 2:
Practice Address - City:ORLEANS
Practice Address - State:MA
Practice Address - Zip Code:02653-9998
Practice Address - Country:US
Practice Address - Phone:508-255-0444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2724152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW15423OtherBCBS OF MASS
MA0335428Medicaid
MA0678590001OtherDMERC
MAW15423OtherBCBS OF MASS
MAT59259Medicare UPIN