Provider Demographics
NPI:1538289137
Name:PIETRETTI, JOSEPH A (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:A
Last Name:PIETRETTI
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:171 GRAMATAN AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-1205
Mailing Address - Country:US
Mailing Address - Phone:914-667-0147
Mailing Address - Fax:914-664-0205
Practice Address - Street 1:171 GRAMATAN AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-1205
Practice Address - Country:US
Practice Address - Phone:914-667-0147
Practice Address - Fax:914-664-0205
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6297156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1258100001Medicare NSC