Provider Demographics
NPI:1154381390
Name:BOZZUTO, JAMES PATRICK (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PATRICK
Last Name:BOZZUTO
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 1:6 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-1806
Mailing Address - Country:US
Mailing Address - Phone:570-654-2020
Mailing Address - Fax:570-655-6516
Practice Address - Street 1:6 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-1806
Practice Address - Country:US
Practice Address - Phone:570-654-2020
Practice Address - Fax:570-655-6516
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000521152W00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001191542Medicaid
PA001191542Medicaid
PA0848750002Medicare NSC
PA0617860003Medicare NSC
PA158507Medicare PIN