Provider Demographics
NPI:1790512911
Name:PITZ, JOANNA
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:PITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 GORDON AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-2911
Mailing Address - Country:US
Mailing Address - Phone:716-262-7823
Mailing Address - Fax:716-681-4249
Practice Address - Street 1:886 NIAGARA FALLS BLVD
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-2006
Practice Address - Country:US
Practice Address - Phone:716-243-4159
Practice Address - Fax:716-692-1238
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010143-01156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician