Provider Demographics
NPI:1700862646
Name:CICCONE, DAVID N (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:N
Last Name:CICCONE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 PRESIDENTIAL PLZ
Mailing Address - Street 2:MADISON TOWER
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-2292
Mailing Address - Country:US
Mailing Address - Phone:315-472-4594
Mailing Address - Fax:315-422-3068
Practice Address - Street 1:60 PRESIDENTIAL PLZ
Practice Address - Street 2:MADISON TOWER
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-2292
Practice Address - Country:US
Practice Address - Phone:315-472-4594
Practice Address - Fax:315-422-3068
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV5682152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7702236OtherAETNA
NY1407469OtherUHC
NY00006384OtherBCBS
NY595013OtherMVP
NY1407469OtherUHC
NYU58027Medicare UPIN