Provider Demographics
NPI:1780023168
Name:LIETTE, PETE THOMAS (OD)
Entity Type:Individual
Prefix:DR
First Name:PETE
Middle Name:THOMAS
Last Name:LIETTE
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 1:3811 STATE ROUTE 705
Mailing Address - Street 2:
Mailing Address - City:NEW WESTON
Mailing Address - State:OH
Mailing Address - Zip Code:45348-9735
Mailing Address - Country:US
Mailing Address - Phone:937-423-1199
Mailing Address - Fax:
Practice Address - Street 1:5688A W BROAD ST
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:OH
Practice Address - Zip Code:43119-8127
Practice Address - Country:US
Practice Address - Phone:614-853-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6217152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist