Provider Demographics
NPI:1750641437
Name:VICCI, CATHERINE M (OD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:M
Last Name:VICCI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 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:121-474-2202
Mailing Address - Fax:
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:972-918-3393
Practice Address - Fax:214-748-2020
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-29
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7812T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX298454YWCHMedicare PIN