Provider Demographics
NPI:1417902289
Name:AUCELLO, PATRICIA ANN (OD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:AUCELLO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 SKY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-2885
Mailing Address - Country:US
Mailing Address - Phone:860-918-1245
Mailing Address - Fax:860-667-0770
Practice Address - Street 1:262 BROCKETT ST
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-3907
Practice Address - Country:US
Practice Address - Phone:860-667-2020
Practice Address - Fax:860-667-0770
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT2192152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTU25153Medicare UPIN
CT410000788Medicare ID - Type Unspecified