Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OEG001533 | PA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OEG001533 | PA |
NPI | 1114922234 |
---|---|
Provider Name | John A. Guzzetti |
First Address | Beaver, PA 15009-1728 |
Second Address | Beaver, PA 15009-1728 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2005 |
Last Update Date | 15/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000904967003 | (05) | PA |
GU150883 | HIGHMARK (01) | PA |
MG1141807 | DEA # (01) | PA |
T29657 | (02) | PA |