Provider Demographics
NPI:1114922234
Name:GUZZETTI, JOHN A (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:GUZZETTI
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 1:212 STATE AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-1728
Mailing Address - Country:US
Mailing Address - Phone:724-774-7559
Mailing Address - Fax:724-774-6557
Practice Address - Street 1:212 STATE AVENUE
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-1728
Practice Address - Country:US
Practice Address - Phone:724-774-7559
Practice Address - Fax:724-774-6557
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001533152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000904967003Medicaid
PAGU150883OtherHIGHMARK
PAGU150883OtherHIGHMARK
PA150883Medicare PIN
PAMG1141807OtherDEA #