Provider Demographics
NPI:1568154342
Name:SCICCHITANO, VICTOR JR (ABO CERTIFIED OPTICI)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:
Last Name:SCICCHITANO
Suffix:JR
Gender:M
Credentials:ABO CERTIFIED OPTICI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 HURON RD
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-2306
Mailing Address - Country:US
Mailing Address - Phone:631-275-8597
Mailing Address - Fax:
Practice Address - Street 1:1890 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-4453
Practice Address - Country:US
Practice Address - Phone:631-369-9055
Practice Address - Fax:631-727-2137
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician