Carmine Petracca

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

License

ODP-634 Issued in ID

Legal business name

CARMINE PETRACCA

Practice address

939 Bryden Ave
Lewiston, ID 83501-5057

Phone

(208) 743-1761

Fax

(208) 746-8042

NPI assigned

Dec 10, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Carmine Petracca, O.D.

Title

Owner

Phone

(208) 743-1761

Specialties & licenses 1

Addresses

Other names 1

• Bryden Family Vision Doing business as

Locations

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

{
    "created_epoch": "1386633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386633600000",
    "number": "1649601006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "939 BRYDEN AVE",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835015057",
            "telephone_number": "208-743-1761",
            "fax_number": "208-746-8042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "939 BRYDEN AVE",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835015057",
            "telephone_number": "208-743-1761",
            "fax_number": "208-746-8042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARMINE PETRACCA",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-10",
        "last_updated": "2013-12-10",
        "status": "A",
        "authorized_official_last_name": "PETRACCA",
        "authorized_official_first_name": "CARMINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-743-1761",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "ID",
            "license": "ODP-634",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bryden Family Vision",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Haley Cardenas, LMSW
• Care Center (Lewiston) Inc.
• Care Connection Home Care
• John W Carlisle, MD
• Mellissa Thell Carman, DOULA
• Dean Carpenter, BS, IS, BIS
• Kailey Marie Carpenter
• Stephanie Margaret Carpenter, PMHNP-C
• Lincoln Carter
• Catalyst Medical Group, PLLC

• Health Service Clinic/Center in Lewiston, ID
• Providers in Lewiston, ID by specialty
• Health Service Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2013; 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.