Provider Demographics
NPI:1437273299
Name:CHECCA, RICHARD ROBERT (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ROBERT
Last Name:CHECCA
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 CHURCH ST
Mailing Address - Street 2:EYE CARE OPTICALS
Mailing Address - City:SARATOGA SPR
Mailing Address - State:NY
Mailing Address - Zip Code:12866
Mailing Address - Country:US
Mailing Address - Phone:518-587-8111
Mailing Address - Fax:518-587-8135
Practice Address - Street 1:254 CHURCH ST
Practice Address - Street 2:EYE CARE OPTICALS
Practice Address - City:SARATOGA SPR
Practice Address - State:NY
Practice Address - Zip Code:12866
Practice Address - Country:US
Practice Address - Phone:518-587-8111
Practice Address - Fax:518-587-8135
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003722156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01660379Medicaid