Provider Demographics
NPI:1962651729
Name:VINCENTE M. SIMONCINI, OD PC
Entity Type:Organization
Organization Name:VINCENTE M. SIMONCINI, OD PC
Other - Org Name:ANNE ARUNDEL FAMILY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENTE
Authorized Official - Middle Name:MARIO
Authorized Official - Last Name:SIMONCINI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:410-266-0001
Mailing Address - Street 1:820 BESTGATE RD
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3404
Mailing Address - Country:US
Mailing Address - Phone:410-266-0001
Mailing Address - Fax:410-266-3988
Practice Address - Street 1:820 BESTGATE RD
Practice Address - Street 2:SUITE 1C
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3404
Practice Address - Country:US
Practice Address - Phone:410-266-0001
Practice Address - Fax:410-266-3988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA 1018152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD157164Medicare PIN