Provider Demographics
NPI:1689010902
Name:CATHERINE M VICCI OD PA
Entity Type:Organization
Organization Name:CATHERINE M VICCI OD PA
Other - Org Name:GOOD VISION OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OD
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:VICCI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:214-742-2020
Mailing Address - Street 1:1050 N WESTMORELAND RD STE 457
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75211-2416
Mailing Address - Country:US
Mailing Address - Phone:214-742-2020
Mailing Address - Fax:214-748-2020
Practice Address - Street 1:1050 N WESTMORELAND RD STE 457
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-2416
Practice Address - Country:US
Practice Address - Phone:214-742-2020
Practice Address - Fax:214-748-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-14
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX322094Medicare PIN
TX322094Medicare UPIN