Individual
DR. JEFFREY MICHAEL PIETRZYK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
540 W NORTH ST, SUITE 209, MANHATTAN, IL 60442-8201
(815) 478-0100
(815) 478-9100
Mailing address
540 W NORTH ST, SUITE 209, MANHATTAN, IL 60442-8201
(815) 478-0100
(815) 478-9100
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046-009714
IL
152W00000X
Optometrist
1553DT
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0009932433
BCBS PIN
—
05
—
046009714
—
IL
01
—
P00313497
MEDICARE RAILROAD PIN
—
Enumeration date
12/02/2005
Last updated
09/17/2012
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