Provider Demographics
NPI:1043380553
Name:TOCCO, ANGELO (OD)
Entity Type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:
Last Name:TOCCO
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 1:20845 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1456
Mailing Address - Country:US
Mailing Address - Phone:313-885-4987
Mailing Address - Fax:313-885-4198
Practice Address - Street 1:20845 MACK AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE
Practice Address - State:MI
Practice Address - Zip Code:48236-1456
Practice Address - Country:US
Practice Address - Phone:313-885-4987
Practice Address - Fax:313-885-4198
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002831152W00000X, 152WC0802X, 152WP0200X, 152WS0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI382191872Medicaid
MIMI1376003Medicare PIN
MI382191872Medicare ID - Type Unspecified
MI382191872Medicaid