Provider Demographics
NPI:1124114442
Name:VIGLUCCI, CHRIS J (OD)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:J
Last Name:VIGLUCCI
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 1:29 N CHENANGO ST
Mailing Address - Street 2:
Mailing Address - City:GREENE
Mailing Address - State:NY
Mailing Address - Zip Code:13778-1139
Mailing Address - Country:US
Mailing Address - Phone:607-656-4485
Mailing Address - Fax:607-656-4648
Practice Address - Street 1:29 N CHENANGO ST
Practice Address - Street 2:
Practice Address - City:GREENE
Practice Address - State:NY
Practice Address - Zip Code:13778-1139
Practice Address - Country:US
Practice Address - Phone:607-656-4485
Practice Address - Fax:607-656-4648
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYUT4205152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY52998CMedicare ID - Type UnspecifiedMEDICARE NUMBER
NYU17110Medicare UPIN