Individual
VINCENT MICHAEL MAGLIOCCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2230 TOWNE LAKE PKWY, BUILDING 700 SUITE 100, WOODSTOCK, GA 30189-5540
(770) 591-3511
(770) 591-3752
Mailing address
2230 TOWNE LAKE PKWY, BUILDING 700 SUITE 100, WOODSTOCK, GA 30189-5540
(770) 591-3511
(770) 591-3752
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
GA2071
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1194771766
NPI
GA
01
—
202I415396
PCAN
GA
Enumeration date
05/25/2006
Last updated
01/16/2013
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