Provider Demographics
NPI:1457395337
Name:AUCELLO, MICHAEL J (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:AUCELLO
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 1:34 SKY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-2885
Mailing Address - Country:US
Mailing Address - Phone:860-667-2020
Mailing Address - Fax:860-667-0770
Practice Address - Street 1:93 EVERGREEN WAY
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-6975
Practice Address - Country:US
Practice Address - Phone:860-644-4362
Practice Address - Fax:860-667-0770
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT2173152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT410000787Medicare ID - Type Unspecified
CTT90617Medicare UPIN