Provider Demographics
NPI:1891791679
Name:VIVIANI, LARAINE LINDA (OD)
Entity Type:Individual
Prefix:DR
First Name:LARAINE
Middle Name:LINDA
Last Name:VIVIANI
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 1:787 WALT WHITMAN RD
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2207
Mailing Address - Country:US
Mailing Address - Phone:631-271-3443
Mailing Address - Fax:
Practice Address - Street 1:787 WALT WHITMAN RD
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-2207
Practice Address - Country:US
Practice Address - Phone:631-271-3443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-25
Last Update Date:2011-10-27
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
NY0005246152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC46171Medicare PIN