Provider Demographics
NPI:1366140774
Name:CAUCCI, MEDIO ANTHONY JR
Entity type:Individual
Prefix:MR
First Name:MEDIO
Middle Name:ANTHONY
Last Name:CAUCCI
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9862 FREMONT DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA STATION
Mailing Address - State:OH
Mailing Address - Zip Code:44028-9609
Mailing Address - Country:US
Mailing Address - Phone:440-864-5724
Mailing Address - Fax:
Practice Address - Street 1:4141 PEARL RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-7649
Practice Address - Country:US
Practice Address - Phone:330-723-0234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOP.007364-SC156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician