Provider Demographics
NPI:1063851285
Name:GAMUZZA, VINCENT JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:JOHN
Last Name:GAMUZZA
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 1:9 SIANO PL
Mailing Address - Street 2:
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1357
Mailing Address - Country:US
Mailing Address - Phone:732-583-3589
Mailing Address - Fax:
Practice Address - Street 1:3810 MORRELL AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1915
Practice Address - Country:US
Practice Address - Phone:732-583-3589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2022-03-01
Deactivation Date:2020-11-15
Deactivation Code:
Reactivation Date:2021-04-28
Provider Licenses
StateLicense IDTaxonomies
PAOEG003130152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist