Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OD.60294099 | WA |
N | 152W00000X | Optometrist | OEG002487 | PA |
NPI | 1003104126 |
---|---|
Provider Name | Dr. Brian John Pietrantonio |
First Address | Olympia, WA 98506-5115 |
Second Address | Olympia, WA 98506-5115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2011 |
Last Update Date | 27/07/2012 |