Individual
MS. LUCIANA MARIE PETITTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
3701 FRANKLIN ST, MICHIGAN CITY, IN 46360-7310
(219) 872-8844
Mailing address
8614 WESTWOOD CENTER DR FL 9, VIENNA, VA 22182-2442
(703) 847-8899
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
046.011192
IL
152W00000X
Optometrist
Primary
18004201A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300032397
—
IN
Enumeration date
07/18/2018
Last updated
05/02/2024
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