Provider Demographics
NPI:1922050707
Name:GIANNONE, JOHN THOMAS (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:THOMAS
Last Name:GIANNONE
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 1:333 E US ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-8920
Mailing Address - Country:US
Mailing Address - Phone:815-942-5918
Mailing Address - Fax:815-942-4794
Practice Address - Street 1:333 E US ROUTE 6
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-8920
Practice Address - Country:US
Practice Address - Phone:815-942-5918
Practice Address - Fax:815-942-4794
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-0006846152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046006846Medicaid
IL046006846Medicaid
ILT37727Medicare UPIN