Provider Demographics
NPI:1245378041
Name:LUCCIO, JAMES A (DO)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:LUCCIO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 MCGRATH HWY
Mailing Address - Street 2:PEARLE VISION CENTER
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143
Mailing Address - Country:US
Mailing Address - Phone:617-623-7522
Mailing Address - Fax:
Practice Address - Street 1:22 MCGRATH HWY
Practice Address - Street 2:PEARLE VISION CENTER
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-4508
Practice Address - Country:US
Practice Address - Phone:617-623-7522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA2671152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0342815Medicaid
MA0342815Medicaid
MAT59321Medicare UPIN