Provider Demographics
NPI:1669520292
Name:BUCCHINO, ROBERT ANTHONY (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ANTHONY
Last Name:BUCCHINO
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 1:18 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08691-1402
Mailing Address - Country:US
Mailing Address - Phone:609-259-6500
Mailing Address - Fax:609-259-6577
Practice Address - Street 1:18 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROBBINSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08691-1402
Practice Address - Country:US
Practice Address - Phone:609-259-6500
Practice Address - Fax:609-259-6577
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ2892152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1903900Medicaid
NJU26662Medicare UPIN
NJ1903900Medicaid