Provider Demographics
NPI:1457542375
Name:CALDERON, VINCENTE A (OD)
Entity Type:Individual
Prefix:DR
First Name:VINCENTE
Middle Name:A
Last Name:CALDERON
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 1:8 DAVISON PLZ
Mailing Address - Street 2:
Mailing Address - City:EAST ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11518-1545
Mailing Address - Country:US
Mailing Address - Phone:347-717-4117
Mailing Address - Fax:347-772-3032
Practice Address - Street 1:8 DAVISON PLZ
Practice Address - Street 2:
Practice Address - City:EAST ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11518-1545
Practice Address - Country:US
Practice Address - Phone:347-717-4117
Practice Address - Fax:347-772-3032
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007143-1152WC0802X, 152W00000X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02904052Medicaid
NYA400043386Medicare PIN