Provider Demographics
NPI:1134334717
Name:JOHN A SISTI OD PA
Entity type:Organization
Organization Name:JOHN A SISTI OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SISTI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:941-966-6206
Mailing Address - Street 1:673 CLEAR CREEK DR
Mailing Address - Street 2:
Mailing Address - City:OSPREY
Mailing Address - State:FL
Mailing Address - Zip Code:34229-6815
Mailing Address - Country:US
Mailing Address - Phone:941-966-6206
Mailing Address - Fax:
Practice Address - Street 1:13140 TAMIAMI TRAIL
Practice Address - Street 2:
Practice Address - City:OSPREY
Practice Address - State:FL
Practice Address - Zip Code:34229-9211
Practice Address - Country:US
Practice Address - Phone:941-966-5459
Practice Address - Fax:941-918-2679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9213Medicare PIN