Provider Demographics
NPI:1316963119
Name:LOCCISANO, ROCCO F (OD)
Entity type:Individual
Prefix:DR
First Name:ROCCO
Middle Name:F
Last Name:LOCCISANO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:400 TROY SCHENECTADY RD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-3211
Mailing Address - Country:US
Mailing Address - Phone:518-785-7891
Mailing Address - Fax:
Practice Address - Street 1:400 TROY SCHENECTADY RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-3211
Practice Address - Country:US
Practice Address - Phone:518-785-7891
Practice Address - Fax:518-785-3927
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004680-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB8169Medicare PIN
NY0654270001Medicare NSC
NYU42837Medicare UPIN