Provider Demographics
NPI:1225491541
Name:NICOTERA, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:NICOTERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2672 W RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GREECE
Mailing Address - State:NY
Mailing Address - Zip Code:14626-3054
Mailing Address - Country:US
Mailing Address - Phone:585-245-0471
Mailing Address - Fax:585-227-3191
Practice Address - Street 1:2672 W RIDGE RD
Practice Address - Street 2:
Practice Address - City:GREECE
Practice Address - State:NY
Practice Address - Zip Code:14626-3054
Practice Address - Country:US
Practice Address - Phone:585-245-0471
Practice Address - Fax:585-227-3191
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician