Provider Demographics
NPI:1730207044
Name:DR. PAUL R. CIACCIO, P.C.
Entity type:Organization
Organization Name:DR. PAUL R. CIACCIO, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:CIACCIO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:508-255-0444
Mailing Address - Street 1:56 MAIN ST
Mailing Address - Street 2:PO BOX 1331
Mailing Address - City:ORLEANS
Mailing Address - State:MA
Mailing Address - Zip Code:02653-9998
Mailing Address - Country:US
Mailing Address - Phone:508-255-0444
Mailing Address - Fax:508-255-0703
Practice Address - Street 1:56 MAIN ST
Practice Address - Street 2:BOX 1331
Practice Address - City:ORLEANS
Practice Address - State:MA
Practice Address - Zip Code:02653-9998
Practice Address - Country:US
Practice Address - Phone:508-255-0444
Practice Address - Fax:508-255-0703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2724152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0335428Medicaid
MA0678590001OtherDMERC
MAW20423OtherBCBS OF MASS
MA0335428Medicaid
MAW20423OtherBCBS OF MASS