Provider Demographics
NPI:1912964735
Name:CERCEO, VINCENT (OD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:
Last Name:CERCEO
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 1:1820 BRIDGETOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-2356
Mailing Address - Country:US
Mailing Address - Phone:215-354-4480
Mailing Address - Fax:215-354-4414
Practice Address - Street 1:1820 BRIDGETOWN PIKE
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-2356
Practice Address - Country:US
Practice Address - Phone:215-354-4480
Practice Address - Fax:215-354-4414
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000738152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U43926Medicare UPIN
PA132409Medicare PIN
PA5489220001Medicare NSC