=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922346469
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PIETRANTONIO OPTOMETRIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2013
-----------------------------------------------------
Last Update Date | 01/17/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 925 BLOSSOM HILL RD STE. 1228
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95123-1230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-281-3926
-----------------------------------------------------
Fax | 408-281-2515
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 925 BLOSSOM HILL RD STE. 1228
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95123-1230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-281-3926
-----------------------------------------------------
Fax | 408-281-2515
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR /OWNER
-----------------------------------------------------
Name | DR. JAMES V PIETRANTONIO
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 408-281-3926
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 10400T
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------