Provider Demographics
NPI:1699777078
Name:RICCIOTTI, KAY R (OD)
Entity type:Individual
Prefix:DR
First Name:KAY
Middle Name:R
Last Name:RICCIOTTI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:865 MERRIAM AVE
Mailing Address - Street 2:SUITE 121
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453
Mailing Address - Country:US
Mailing Address - Phone:978-537-6045
Mailing Address - Fax:978-534-9845
Practice Address - Street 1:865 MERRIAM AVE
Practice Address - Street 2:SUITE 121
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453
Practice Address - Country:US
Practice Address - Phone:978-537-6045
Practice Address - Fax:978-534-9845
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4215152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110014769AMedicaid
MA152823OtherHPHC
MA91559OtherFALLON
MA974271OtherNETWORK HEALTH
MA3026088OtherAETNA
MAW16291OtherBLUE CROSS
MA0334961Medicaid
MA65269OtherCIGNA
MA110014769AMedicaid
MA0334961Medicaid