Provider Demographics
NPI:1477624542
Name:IANNITTO, JOHN JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:IANNITTO
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 1:27 HEARD DR
Mailing Address - Street 2:
Mailing Address - City:IPSWICH
Mailing Address - State:MA
Mailing Address - Zip Code:01938-1628
Mailing Address - Country:US
Mailing Address - Phone:978-621-9828
Mailing Address - Fax:
Practice Address - Street 1:180 ENDICOTT ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3683
Practice Address - Country:US
Practice Address - Phone:978-774-4500
Practice Address - Fax:978-774-0974
Is Sole Proprietor?:No
Enumeration Date:2006-11-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3131152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0354074Medicaid
MA431158Medicare ID - Type Unspecified
MA0354074Medicaid