Provider Demographics
NPI:1669446522
Name:GIANNOTTI, ANTHONY P (OD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:P
Last Name:GIANNOTTI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:221 MOUNT HERMON RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-4038
Mailing Address - Country:US
Mailing Address - Phone:831-438-4482
Mailing Address - Fax:831-438-7360
Practice Address - Street 1:221 MOUNT HERMON RD
Practice Address - Street 2:SUITE G
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-4038
Practice Address - Country:US
Practice Address - Phone:831-438-4482
Practice Address - Fax:831-438-7360
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6667 TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0190260001Medicare NSC
CAT10390Medicare UPIN
CASD0066670Medicare PIN