Provider Demographics
NPI:1538376207
Name:LAURA M GIANELLI OD & WALTER R RECECONI OD, PC
Entity type:Organization
Organization Name:LAURA M GIANELLI OD & WALTER R RECECONI OD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:R
Authorized Official - Last Name:RECECONI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:503-325-4401
Mailing Address - Street 1:577 18TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-3505
Mailing Address - Country:US
Mailing Address - Phone:503-325-4401
Mailing Address - Fax:503-325-3278
Practice Address - Street 1:577 18TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3505
Practice Address - Country:US
Practice Address - Phone:503-325-4401
Practice Address - Fax:503-325-3278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2022ATI 1994ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1994ATIOtherLICENSE
OR150738Medicaid
OR2022ATIOtherLICENSE
OR1994ATIOtherLICENSE
U13390Medicare UPIN
T91791Medicare UPIN