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General NPI Number Information
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NPI Number | 1730551441
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Entity Type | Organization
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Legal Business Name | DR SUSAN PIETROWSKI, OPTOMETRIST LLC
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Dates
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Enumeration Date | 10/21/2015
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Last Update Date | 10/21/2015
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Provider Practice Location Address
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Address Line | 4630 MONTICELLO AVE
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-8200
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Country | US
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Telephone | 757-253-7901
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5651
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-5210
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Country | US
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Telephone | 757-253-7501
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. SUSAN PIETROWSKI
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Credential |
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Telephone | 757-253-7901
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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 | 0618001739
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License Number State | VA
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