Basic Information
| Provider Information | |||||||||
| NPI: | 1457395337 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AUCELLO | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34 SKY VIEW DR | ||||||||
| Address2: | |||||||||
| City: | AVON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060012885 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606672020 | ||||||||
| FaxNumber: | 8606670770 | ||||||||
| Practice Location | |||||||||
| Address1: | 93 EVERGREEN WAY | ||||||||
| Address2: | |||||||||
| City: | SOUTH WINDSOR | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060746975 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606444362 | ||||||||
| FaxNumber: | 8606670770 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 09/05/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | CT2173 | CT | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.