Individual
DR. BRIAN JOHN PETRACCA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1515 S 8TH ST, DEMING, NM 88030-4940
(575) 544-3937
(575) 546-2870
Mailing address
4800 N 22ND ST STE 210, PHOENIX, AZ 85016-4963
(480) 892-8400
(602) 508-4830
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
592
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14224283
—
NM
Enumeration date
10/09/2008
Last updated
04/25/2023
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