Provider Demographics
NPI:1851368419
Name:FERRUCCI, VANESSA (OD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:
Last Name:FERRUCCI
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 1:14610 MORRISON ST
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1649
Mailing Address - Country:US
Mailing Address - Phone:818-789-2809
Mailing Address - Fax:
Practice Address - Street 1:4100 W ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4195
Practice Address - Country:US
Practice Address - Phone:818-841-1212
Practice Address - Fax:818-841-6768
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2016-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12117T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASDO12117OMedicaid
CAWOP12117BMedicare ID - Type Unspecified
CASDO12117OMedicaid