Provider Demographics
NPI:1851497176
Name:D'AMICO, DAVID E
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:D'AMICO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 MILE CROSSING BLVD STE 1B
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-6242
Mailing Address - Country:US
Mailing Address - Phone:585-571-9034
Mailing Address - Fax:585-471-8827
Practice Address - Street 1:250 MILE CROSSING BLVD STE 1B
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-6242
Practice Address - Country:US
Practice Address - Phone:585-571-9034
Practice Address - Fax:585-471-8827
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004657152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0837970001Medicare NSC
NYT26100Medicare UPIN
NYCC9308Medicare ID - Type Unspecified