Individual
DR. JIMMIE IGNAZIO CICCARELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
620 SEASIDE DR, TARPON SPRINGS, FL 34689-2293
(609) 458-4541
Mailing address
620 SEASIDE DR, TARPON SPRINGS, FL 34689-2293
(609) 458-4541
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
27OA00545000
NJ
152W00000X
Optometrist
Primary
OPC 5167
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2204890
AETNA
NJ
01
—
NJ5450
EYEMED
NJ
Enumeration date
06/16/2006
Last updated
04/18/2016
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