Organization
GERARD A.COLUCCELLI,M.D.
Active
Other names
SEE CLEAR OPTICAL
Organization subpart
No
Provider details
NPI number
Authorized official
GERARD A COLUCCELLI M.D. (OWNER)
(904) 398-2111
Entity
Organization
Contact information
Practice address
1235 SAN MARCO BLVD, SUITE 401, JACKSONVILLE, FL 32207-8554
(904) 398-2111
(904) 346-0712
Mailing address
1235 SAN MARCO BLVD, SUITE 401, JACKSONVILLE, FL 32207-8554
(904) 398-2111
(904) 346-0712
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
ME39542
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15671
BCBS
FL
01
—
15671X
MEDICARE
FL
01
—
3948990001
DMARC
FL
01
—
4045150
AETNA
FL
Enumeration date
08/25/2006
Last updated
11/14/2007
Update your record
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