Individual
MARIO J. ANDREATTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OP2438
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006007
AHCCCS
AZ
05
—
152W0000X
—
NM
01
—
NM0438
EYE MED ID
—
01
—
NMOP2438
LICENSE #
NM
Enumeration date
07/13/2005
Last updated
04/23/2008
Update your record
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