Provider Demographics
NPI:1447289152
Name:VINCELLI, NICHOLAS CLINTON (OD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:CLINTON
Last Name:VINCELLI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:118 N OAK AVE
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-2311
Mailing Address - Country:US
Mailing Address - Phone:507-451-3072
Mailing Address - Fax:507-451-4291
Practice Address - Street 1:118 N OAK AVE
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-2311
Practice Address - Country:US
Practice Address - Phone:507-451-3072
Practice Address - Fax:507-451-4291
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist