Provider Demographics
NPI:1093130551
Name:PONTIERO MEANDZIJA, JEANNETTE (OD)
Entity Type:Individual
Prefix:MRS
First Name:JEANNETTE
Middle Name:
Last Name:PONTIERO MEANDZIJA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JEANNETTE
Other - Middle Name:
Other - Last Name:PONTIERO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:8259 S CHICKASAW LN
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-2048
Mailing Address - Country:US
Mailing Address - Phone:385-210-6867
Mailing Address - Fax:
Practice Address - Street 1:2727 W 3500 S
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-3106
Practice Address - Country:US
Practice Address - Phone:801-968-6772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-20
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8898869-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist