=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356311187
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES W. VENUTO O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 413 W. CYPRESS ST.
-----------------------------------------------------
City | KENNETT SQ.
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-444-0808
-----------------------------------------------------
Fax | 610-444-0809
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 413 W. CYPRESS ST.
-----------------------------------------------------
City | KENNETT SQ.
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-444-0808
-----------------------------------------------------
Fax | 610-444-0809
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OE-04292-P
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------