Provider Demographics
NPI:1093971533
Name:PETTITT, JOCELYN ROSE (OD)
Entity Type:Individual
Prefix:DR
First Name:JOCELYN
Middle Name:ROSE
Last Name:PETTITT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7200 MENTOR AVE
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-7522
Mailing Address - Country:US
Mailing Address - Phone:440-946-8809
Mailing Address - Fax:440-269-7942
Practice Address - Street 1:7200 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-7522
Practice Address - Country:US
Practice Address - Phone:440-946-8809
Practice Address - Fax:440-269-7942
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5814152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist