Provider Demographics
NPI:1497842850
Name:TRICARICO, ROBERT DANIEL (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DANIEL
Last Name:TRICARICO
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 464
Mailing Address - Street 2:3586 RT 22 W
Mailing Address - City:WHITEHOUSE STATION
Mailing Address - State:NJ
Mailing Address - Zip Code:08889
Mailing Address - Country:US
Mailing Address - Phone:908-534-9892
Mailing Address - Fax:908-534-2482
Practice Address - Street 1:3586 RT 22 W
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE STATION
Practice Address - State:NJ
Practice Address - Zip Code:08889
Practice Address - Country:US
Practice Address - Phone:908-534-9892
Practice Address - Fax:908-534-2482
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00377400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ310999OtherNATIONAL VIS ADMIN
NJ51165OtherDAVIS VISION
NJ51165OtherDAVIS VISION