Provider Demographics
NPI:1952300824
Name:VINCI, DAVID JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOHN
Last Name:VINCI
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 1:6 HEADWATERS PLZ
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13309-1300
Mailing Address - Country:US
Mailing Address - Phone:315-942-2122
Mailing Address - Fax:
Practice Address - Street 1:6 HEADWATERS PLZ
Practice Address - Street 2:ADIRONDACK EYE CARE
Practice Address - City:BOONVILLE
Practice Address - State:NY
Practice Address - Zip Code:13309-1300
Practice Address - Country:US
Practice Address - Phone:315-942-2122
Practice Address - Fax:315-942-2084
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006918152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1215036405OtherGROUP NPI
NY1215036405OtherGROUP NPI