Provider Demographics
NPI:1689416489
Name:VIGLIOTTI, VINCENT
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:VIGLIOTTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3951 W ASHLEY CIR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-9156
Mailing Address - Country:US
Mailing Address - Phone:843-762-2318
Mailing Address - Fax:
Practice Address - Street 1:3951 W ASHLEY CIR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-9156
Practice Address - Country:US
Practice Address - Phone:843-763-2318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1127156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician