Provider Demographics
NPI:1356475073
Name:VARRICCHIO, RICHARD ALFRED (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALFRED
Last Name:VARRICCHIO
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:PO BOX 41
Mailing Address - Street 2:
Mailing Address - City:TALLMAN
Mailing Address - State:NY
Mailing Address - Zip Code:10982-0041
Mailing Address - Country:US
Mailing Address - Phone:845-368-2202
Mailing Address - Fax:845-368-2659
Practice Address - Street 1:296 ROUTE 59
Practice Address - Street 2:12
Practice Address - City:TALLMAN
Practice Address - State:NY
Practice Address - Zip Code:10982-0041
Practice Address - Country:US
Practice Address - Phone:845-368-2202
Practice Address - Fax:845-368-2659
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004617-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY453OtherDAVIS
NYNY4617OtherEYEMED
1069410001OtherMEDICARE DMERC
NY90975OtherAETNA
NY90975OtherAETNA