Provider Demographics
NPI:1558424572
Name:RICCIARDI, VALARIE A (OD)
Entity Type:Individual
Prefix:DR
First Name:VALARIE
Middle Name:A
Last Name:RICCIARDI
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 1:335 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-1000
Mailing Address - Country:US
Mailing Address - Phone:508-753-5103
Mailing Address - Fax:508-753-6395
Practice Address - Street 1:335 PARK AVE
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-1000
Practice Address - Country:US
Practice Address - Phone:508-753-5103
Practice Address - Fax:508-753-6395
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3453152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
301680OtherCIGNA
MA0354384Medicaid
MA9715070Medicaid
725511OtherTUFTS
MA9715070Medicaid
MAW21059Medicare ID - Type UnspecifiedGROUP NUMBER
301680OtherCIGNA