Provider Demographics
NPI:1285701680
Name:PIETRANTONIO, JIM (O D)
Entity type:Individual
Prefix:DR
First Name:JIM
Middle Name:
Last Name:PIETRANTONIO
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 N SANTA CRUZ AVE
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-7206
Mailing Address - Country:US
Mailing Address - Phone:408-354-9310
Mailing Address - Fax:
Practice Address - Street 1:233 N SANTA CRUZ AVE
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-7206
Practice Address - Country:US
Practice Address - Phone:408-354-9310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10400T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU43859Medicare UPIN