Provider Demographics
NPI:1346442043
Name:J PIETRANTONIO OD INC
Entity Type:Organization
Organization Name:J PIETRANTONIO OD INC
Other - Org Name:LOS GATOS OPTOMETRIC VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:PIETRANTONIO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:408-354-9310
Mailing Address - Street 1:233 N SANTA CRUZ AVE
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-7206
Mailing Address - Country:US
Mailing Address - Phone:408-354-9310
Mailing Address - Fax:408-354-5889
Practice Address - Street 1:233 N SANTA CRUZ AVE
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-7206
Practice Address - Country:US
Practice Address - Phone:408-354-9310
Practice Address - Fax:408-354-5889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10400T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ02166ZMedicare PIN
CA5614830001Medicare NSC
CAZZZ02166ZMedicare ID - Type Unspecified
CAU43859Medicare UPIN