Provider Demographics
NPI:1861470601
Name:BUCCIERO, FRANK R (OD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:R
Last Name:BUCCIERO
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 1:100 MORRIS AVE
Mailing Address - Street 2:BLDG A
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081
Mailing Address - Country:US
Mailing Address - Phone:973-376-3151
Mailing Address - Fax:973-376-3153
Practice Address - Street 1:100 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081
Practice Address - Country:US
Practice Address - Phone:973-376-3151
Practice Address - Fax:973-376-3153
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2010-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00454500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0734608Medicaid
U27460Medicare UPIN
NJ707628MP7Medicare ID - Type Unspecified