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NPI Code Detail

MEDICARE: DR. JADE PESTRITTO OD

MEDICARE:  DR. JADE  PESTRITTO  OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist6131FL

General Provider Information

NPI Number : 1063146058
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JADE PESTRITTO OD
Provider Business Mailing Address
First Line : 6200 SW 6TH ST
Second Line :
City : MARGATE
State : FL
Zip : 33068-1709
Country : US
Telephone Number : 954-531-3507
Fax Number :
Provider Business Practice Location Address
First Line : 2120 S FEDERAL HWY
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33316-3545
Country : US
Telephone Number : 954-467-3777
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2022
Last Update Date : 07/14/2022

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Directions to “ DR. JADE PESTRITTO OD” Practice Location

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