Healthcare Provider Details

I. General information

NPI: 1154381390
Provider Name (Legal Business Name): JAMES PATRICK BOZZUTO O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 04/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 N MAIN ST
PITTSTON PA
18640-1806
US

IV. Provider business mailing address

6 N MAIN ST
PITTSTON PA
18640-1806
US

V. Phone/Fax

Practice location:
  • Phone: 570-654-2020
  • Fax: 570-655-6516
Mailing address:
  • Phone: 570-654-2020
  • Fax: 570-655-6516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberOEG000521
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000521
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: