Provider Demographics
NPI:1881861003
Name:LAROCCA, ELVIRO EGISTO (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:ELVIRO
Middle Name:EGISTO
Last Name:LAROCCA
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PLEASANT ST
Mailing Address - Street 2:APT# 502
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14604-1455
Mailing Address - Country:US
Mailing Address - Phone:585-705-0974
Mailing Address - Fax:
Practice Address - Street 1:379 PARK AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-2807
Practice Address - Country:US
Practice Address - Phone:585-705-0974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008610-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician