Provider Demographics
NPI:1821155367
Name:RICCIARDI, ROBERT ANIELLO (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ANIELLO
Last Name:RICCIARDI
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 1:8 CHELSEA ST
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-3501
Mailing Address - Country:US
Mailing Address - Phone:617-387-5344
Mailing Address - Fax:
Practice Address - Street 1:8 CHELSEA ST
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-3501
Practice Address - Country:US
Practice Address - Phone:617-387-5344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3367152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0353728Medicaid
MAT59438Medicare UPIN
MA0353728Medicaid