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General NPI Number Information
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NPI Number | 1487713335
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Entity Type | Individual
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Provider Name | JOHN ALGREN PETTIT O.D.
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Gender | Male
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Dates
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Enumeration Date | 12/07/2006
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Last Update Date | 01/03/2011
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Provider Practice Location Address
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Address Line | 1480 US HIGHWAY 17 N INSIDE WALMART VISION
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City | WAUCHULA
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State | FL
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Zip | 33873-5006
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Country | US
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Telephone | 863-448-3790
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Fax | 941-918-2679
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Provider Business Mailing Address
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Address Line | 1230 CORNISH CT
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City | SARASOTA
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State | FL
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Zip | 34232-3042
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Country | US
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Telephone | 941-377-4417
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Fax | 941-918-2679
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1551
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License Number State | FL
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