Provider Demographics
NPI:1356330914
Name:LUCCHETTI, VINCENT DINO (OD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:DINO
Last Name:LUCCHETTI
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 1:200 MEDICAL ARTS BLDG
Mailing Address - Street 2:SUITE 210
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-7132
Mailing Address - Country:US
Mailing Address - Phone:724-543-2146
Mailing Address - Fax:724-545-9678
Practice Address - Street 1:200 MEDICAL ARTS BLDG
Practice Address - Street 2:SUITE 210
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-7132
Practice Address - Country:US
Practice Address - Phone:724-543-2146
Practice Address - Fax:724-545-9678
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0EG001016152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
410047375OtherRAILROAD MEDICARE
PA0017633800003Medicaid
410047375OtherRAILROAD MEDICARE
PA0017633800003Medicaid