Philip L Bertucci,MD,LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

435023614 Issued in GA

Legal business name

PHILIP L BERTUCCI,MD,LLC

Doing business as

Statesboro Eyewear

Practice address

21 N Zetterower Ave
Statesboro, GA 30458-7142

Phone

(912) 764-7010

Fax

(912) 764-5827

NPI assigned

Jun 18, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Philip L Bertucci, M.D.

Title

Owner

Phone

(912) 764-7010

Specialties & licenses 1

Addresses

Other names 1

• Statesboro Eyewear Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1213747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213747200000",
    "number": "1356502884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 N ZETTEROWER AVE",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304587142",
            "telephone_number": "912-764-7010",
            "fax_number": "912-764-5827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 N ZETTEROWER AVE",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304587142",
            "telephone_number": "912-764-7010",
            "fax_number": "912-764-5827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILIP L BERTUCCI,MD,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-18",
        "last_updated": "2008-06-18",
        "status": "A",
        "authorized_official_last_name": "BERTUCCI",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-764-7010",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "GA",
            "license": "435023614",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Statesboro Eyewear",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Caroline Eliabeth Peterson
• Richard Petrella Sr., MD
• Victoria Pettofrezzo, PT, DPT
• Brandy Anne Petty, M.S., ATC, LAT
• Heather Petty
• Allison Paige Phillips
• Loriann Leggett Phillips, M.S, LAT, ATC
• Matthew Phillips, MD
• Julie Pickens, CRC
• Kimberly Pierce, CCC-SLP

• Durable Medical Equipment & Medical Supplies in Statesboro, GA
• Providers in Statesboro, GA by specialty
• Durable Medical Equipment & Medical Supplies in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.