Provider Demographics
NPI:1497161178
Name:GIANFRIDDO, JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:GIANFRIDDO
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 1:3423 S GLENDALE DR
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-4433
Mailing Address - Country:US
Mailing Address - Phone:217-316-5537
Mailing Address - Fax:
Practice Address - Street 1:3236 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-3712
Practice Address - Country:US
Practice Address - Phone:217-228-2060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.010825152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist