Provider Demographics
NPI:1316722549
Name:JUNTTILA, JESSE (OD)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:JUNTTILA
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 1:7501 E MCDOWELL RD APT 1007
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-3553
Mailing Address - Country:US
Mailing Address - Phone:906-231-1160
Mailing Address - Fax:
Practice Address - Street 1:1703 W BETHANY HOME RD STE C3
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-7066
Practice Address - Country:US
Practice Address - Phone:602-944-2444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOPT-002742152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist