Provider Demographics
NPI:1972664977
Name:GIOVANNUCCI, VINCENT DOMENIC (OD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:DOMENIC
Last Name:GIOVANNUCCI
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 1:19 GLEN GERY RD
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-1676
Mailing Address - Country:US
Mailing Address - Phone:508-842-5629
Mailing Address - Fax:
Practice Address - Street 1:348 SHREWSBURY ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-4616
Practice Address - Country:US
Practice Address - Phone:508-798-2421
Practice Address - Fax:508-754-9093
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2907152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA36521OtherCOLE
MA22-00899OtherUNITED HEALTHCARE
MA9956OtherDAVIS
MA152132OtherHARVARD PILGRIM
MA2948700OtherAETNA
MA002907OtherTUFTS
MA2508319OtherCIGNA
MA0355984Medicaid
MA2508319OtherCIGNA
MA152132OtherHARVARD PILGRIM