Provider Demographics
NPI:1558614636
Name:RICHARD A VARRICCHIO OD PC
Entity Type:Organization
Organization Name:RICHARD A VARRICCHIO OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:VARRICCHIO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:845-368-2202
Mailing Address - Street 1:PO BOX 41
Mailing Address - Street 2:
Mailing Address - City:TALLMAN
Mailing Address - State:NY
Mailing Address - Zip Code:10982-0041
Mailing Address - Country:US
Mailing Address - Phone:845-368-2202
Mailing Address - Fax:845-368-2659
Practice Address - Street 1:296 ROUTE 59
Practice Address - Street 2:12
Practice Address - City:TALLMAN
Practice Address - State:NY
Practice Address - Zip Code:10982-0041
Practice Address - Country:US
Practice Address - Phone:845-368-2202
Practice Address - Fax:845-368-2659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-26
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004617-1152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1069410001OtherDMERC
NY4617OtherEYEMED
NY453OtherDAVIS VISION
NY90975OtherAETNA
NY90975OtherAETNA