MEDICARE: MRS. JAMIE LYNN MAGNOTTA 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
1	152W00000X	Optometrist	OEG002121	PA

General Provider Information

NPI Number	:	1295985463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JAMIE LYNN MAGNOTTA OD

Provider Business Mailing Address
First Line	:	100 EVERGREEN DR
Second Line	:	STE 117 PEARLE VISION
City	:	GLEN MILLS
State	:	PA
Zip	:	19342-1056
Country	:	US
Telephone Number	:	610-558-9803
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 EVERGREEN DR
Second Line	:	STE 117 PEARLE VISION
City	:	GLEN MILLS
State	:	PA
Zip	:	19342-1056
Country	:	US
Telephone Number	:	610-558-9803
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2008
Last Update Date	:	09/24/2008

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