Provider Demographics
NPI:1649394289
Name:RICHARD NUCCIO PC
Entity type:Organization
Organization Name:RICHARD NUCCIO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:NUCCIO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-980-9095
Mailing Address - Street 1:136 W LAKE ST
Mailing Address - Street 2:STE 110
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1020
Mailing Address - Country:US
Mailing Address - Phone:630-980-9095
Mailing Address - Fax:630-980-9156
Practice Address - Street 1:136 W LAKE ST
Practice Address - Street 2:STE 110
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1020
Practice Address - Country:US
Practice Address - Phone:630-980-9095
Practice Address - Fax:630-980-9156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty