Provider Demographics
NPI:1629246004
Name:ROCCO F LOCCISANO & ROBERTA BASILE LOCCISANO PTRS.
Entity Type:Organization
Organization Name:ROCCO F LOCCISANO & ROBERTA BASILE LOCCISANO PTRS.
Other - Org Name:LATHAM FAMILY VISION
Other - Org Type:Other Name
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROCCO
Authorized Official - Middle Name:F
Authorized Official - Last Name:LOCCISANO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:518-785-7891
Mailing Address - Street 1:400 TROY SCHENECTADY RD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-3211
Mailing Address - Country:US
Mailing Address - Phone:518-785-7891
Mailing Address - Fax:
Practice Address - Street 1:400 TROY SCHENECTADY RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-3211
Practice Address - Country:US
Practice Address - Phone:518-785-7891
Practice Address - Fax:518-785-3927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004680-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0654270001Medicare NSC
NYBA1459Medicare PIN
NYU42837Medicare UPIN