Carmine Petracca

NPI #1649601006 in Lewiston, Idaho

Provider Information

NPI Number
1649601006
Entity Type
Organization
Organization Name
Carmine Petracca
Primary Specialty
Clinic/Center - Health Service
Enumeration Date
Dec 10, 2013
Last Updated
Dec 10, 2013

Practice Location

Address
939 BRYDEN AVE
State
Idaho
ZIP Code
83501-5057
Phone
(208) 743-1761

Authorized Official

Name
DR. CARMINE PETRACCA, O.D.
Title
OWNER
Phone
(208) 743-1761

Specialties & Taxonomy Codes

Specialty
Clinic/Center - Health ServiceHealth Service

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