Individual
DR. PETER JOSEPH MICCA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2100 CLINTON AVE S, ROCHESTER, NY 14618-2616
(585) 244-6011
(585) 244-0236
Mailing address
2100 CLINTON AVE S, ROCHESTER, NY 14618-2616
(585) 244-6011
(585) 244-0236
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV004870
NY
152WC0802X
Corneal and Contact Management Optometrist
TUV004870
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P011004870
BCBS
NY
Enumeration date
01/24/2006
Last updated
08/19/2014
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