Provider Demographics
NPI:1851359558
Name:VRICELLA, MARILYN (OD)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:VRICELLA
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 1:33 W 42ND ST
Mailing Address - Street 2:OPTOMETRIC CENTER SUNY COLLEGE OF OPTOMETRY
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-8003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:33 W 42ND ST
Practice Address - Street 2:OPTOMETRIC CENTER SUNY COLLEGE OF OPTOMETRY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-8003
Practice Address - Country:US
Practice Address - Phone:212-938-4157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005896152W00000X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics