Provider Demographics
NPI:1376764555
Name:PARTTE, JOSEPH HENRY JR (ASSOCIATE DEGDREE)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:HENRY
Last Name:PARTTE
Suffix:JR
Gender:M
Credentials:ASSOCIATE DEGDREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 W. PHILOMENA DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001
Mailing Address - Country:US
Mailing Address - Phone:928-774-1536
Mailing Address - Fax:
Practice Address - Street 1:1061-A SOUTH PLAZA WAY
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001
Practice Address - Country:US
Practice Address - Phone:928-779-0398
Practice Address - Fax:928-774-4324
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ622156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician