Provider Demographics
NPI:1174524896
Name:BIESTEK, JOHN (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:BIESTEK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:35 PLEASENT ST
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450
Mailing Address - Country:US
Mailing Address - Phone:203-235-4462
Mailing Address - Fax:203-238-4436
Practice Address - Street 1:35 PLEASENT ST
Practice Address - Street 2:SUITE 2C
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450
Practice Address - Country:US
Practice Address - Phone:203-235-4462
Practice Address - Fax:203-238-4436
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2014-09-17
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
CT061102660152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist