Provider Demographics
NPI:1194988956
Name:PORCELLO, DANIELLE M (OD)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:M
Last Name:PORCELLO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2921 ERIE BLVD E
Mailing Address - Street 2:EMPIRE VISION CENTER, INC
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224-1430
Mailing Address - Country:US
Mailing Address - Phone:315-446-3145
Mailing Address - Fax:315-445-7675
Practice Address - Street 1:309 313 MERRICK ROAD, 3
Practice Address - Street 2:DAVIS VISION
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-5325
Practice Address - Country:US
Practice Address - Phone:516-536-1031
Practice Address - Fax:516-536-1073
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007290152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist