Provider Demographics
NPI:1366634321
Name:PIZZINI, CAMILLE M (OD)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:M
Last Name:PIZZINI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 AVE J T PINERO
Mailing Address - Street 2:ALTAMIRA XTRA SHOPPING CENTER
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-1102
Mailing Address - Country:US
Mailing Address - Phone:787-775-4098
Mailing Address - Fax:
Practice Address - Street 1:1900 AVE J T PINERO
Practice Address - Street 2:ALTAMIRA XTRA SHOPPING CENTER
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-1102
Practice Address - Country:US
Practice Address - Phone:787-775-4098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR626152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist