Individual
CHARLES W FICCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
970 SANDERS RD STE 100, CUMMING, GA 30041
(678) 381-2020
(678) 381-2015
Mailing address
1300 PEACHTREE INDUSTRIAL BLVD STE 1201, SUWANEE, GA 30024-4550
(678) 381-2020
(678) 381-2015
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT01583
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000741815A
—
GA
01
—
C16012
RAILROAD MEDICARE
GA
Enumeration date
09/12/2005
Last updated
10/22/2019
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