Provider Demographics
NPI:1558493775
Name:VICKERS, JOHN D (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:VICKERS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3330 VETERANS MEMORIAL HWY
Mailing Address - Street 2:SUITE9
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-1036
Mailing Address - Country:US
Mailing Address - Phone:631-285-6789
Mailing Address - Fax:631-285-7105
Practice Address - Street 1:3330 VETERANS MEMORIAL HWY
Practice Address - Street 2:SUITE9
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-1036
Practice Address - Country:US
Practice Address - Phone:631-285-6789
Practice Address - Fax:631-285-7105
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY198664207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01899265Medicaid
NYG31173Medicare UPIN
NY385A11Medicare ID - Type Unspecified