Provider Demographics
NPI:1447305321
Name:CRISPINO, VINCENT JAMES (OD)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:JAMES
Last Name:CRISPINO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1754 GOLF VIEW DR
Mailing Address - Street 2:
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022-2580
Mailing Address - Country:US
Mailing Address - Phone:715-426-1237
Mailing Address - Fax:
Practice Address - Street 1:1754 GOLF VIEW DR
Practice Address - Street 2:
Practice Address - City:RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54022-2580
Practice Address - Country:US
Practice Address - Phone:715-426-1237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2233152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T96811Medicare UPIN