Provider Demographics
NPI:1386785814
Name:PICCIONE, JERRY A (OD)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:A
Last Name:PICCIONE
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 1:44 SHERWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-6146
Mailing Address - Country:US
Mailing Address - Phone:518-588-8513
Mailing Address - Fax:
Practice Address - Street 1:279 TROY RD
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:NY
Practice Address - Zip Code:12144-9499
Practice Address - Country:US
Practice Address - Phone:518-286-9910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT005608152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist