Healthcare Provider Details

I. General information

NPI: 1952661837
Provider Name (Legal Business Name): ANTHONY P. GIANNOTTI OD PROFESSIONAL OPTOMETRIC CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 06/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 MOUNT HERMON RD SUITE O
SCOTTS VALLEY CA
95066-4010
US

IV. Provider business mailing address

266 MOUNT HERMON RD SUITE O
SCOTTS VALLEY CA
95066-4010
US

V. Phone/Fax

Practice location:
  • Phone: 831-438-4482
  • Fax: 831-438-7360
Mailing address:
  • Phone: 831-438-4482
  • Fax: 831-438-7360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT6667TLG
License Number StateCA

VIII. Authorized Official

Name: DR. ANTHONY P GIANNOTTI
Title or Position: PRESIDENT AND CEO
Credential: O.D.
Phone: 831-438-4482