# DR. JIMMIE IGNAZIO CICCARELLO

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1144264110
- **Gender:** Man
- **Credential:** O.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | 27OA00545000 | NJ | — |
| 152W00000X | Optometrist | OPC 5167 | FL | Yes |

## Other

- **Enumeration date:** 06/16/2006
- **Last updated:** 04/18/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2204890 | AETNA | NJ |
| 01 | — | NJ5450 | EYEMED | NJ |