Provider Demographics
NPI:1205911419
Name:FACCHINEI, VINCENT ADRIAN (OD)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:ADRIAN
Last Name:FACCHINEI
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 1:19336 LEITERSBURG PIKE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742
Mailing Address - Country:US
Mailing Address - Phone:717-532-8806
Mailing Address - Fax:717-532-3421
Practice Address - Street 1:341 BALTIMORE ROAD
Practice Address - Street 2:
Practice Address - City:SHIPPENSBURG
Practice Address - State:PA
Practice Address - Zip Code:17257
Practice Address - Country:US
Practice Address - Phone:717-532-8806
Practice Address - Fax:717-532-3421
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000795152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
410046908OtherRAILROAD MEDICARE
PAFA647416OtherHIGHMARK BLUE SHIELD
PA0012341110006Medicaid
PA0012341110006Medicaid
U48797Medicare UPIN