Provider Demographics
NPI:1396704466
Name:FORTE-GUAETTA, JANE ANNE (OD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:ANNE
Last Name:FORTE-GUAETTA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JANE
Other - Middle Name:ANNE
Other - Last Name:FORTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3950 TECPORT DR STE 170
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-1472
Mailing Address - Country:US
Mailing Address - Phone:717-564-5211
Mailing Address - Fax:717-564-5280
Practice Address - Street 1:3950 TECPORT DR STE 170
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-1472
Practice Address - Country:US
Practice Address - Phone:717-564-5211
Practice Address - Fax:717-564-5280
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-18
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000009152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
F0817163OtherPID
F0817163OtherPID