Provider Demographics
NPI:1396100939
Name:PATRICK DEL VECCHIO, PA
Entity type:Organization
Organization Name:PATRICK DEL VECCHIO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-542-8669
Mailing Address - Street 1:28 N HOMESTEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-7416
Mailing Address - Country:US
Mailing Address - Phone:305-247-2334
Mailing Address - Fax:305-247-7101
Practice Address - Street 1:28 N HOMESTEAD BLVD
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-7416
Practice Address - Country:US
Practice Address - Phone:305-247-2334
Practice Address - Fax:305-247-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4015152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty