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NPI Code Detail

MEDICARE: DR. LARA PEDRETTI O.D.

MEDICARE: DR. LARA PEDRETTI O.D.
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
1152W00000XOptometrist2670WI
2152W00000XOptometrist5517TTX

General Provider Information

NPI Number : 1750339628
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LARA PEDRETTI O.D.
Provider Business Mailing Address
First Line : 7717 N ORANGE PRAIRIE RD
Second Line :
City : PEORIA
State : IL
Zip : 61615-9323
Country : US
Telephone Number : 309-589-6800
Fax Number : 309-589-6994
Provider Business Practice Location Address
First Line : 7717 N ORANGE PRAIRIE RD
Second Line :
City : PEORIA
State : IL
Zip : 61615-9323
Country : US
Telephone Number : 309-589-6800
Fax Number : 309-589-6994
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2006
Last Update Date : 04/01/2013

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