Bobby J Pettit

Primary specialty

OpticianTaxonomy code 156FX1800X

License

644 Issued in AZ

Practice address

5830 W Thunderbird Rd Ste B5
Glendale, AZ 85306-4655

Phone

(602) 841-7886

NPI assigned

Oct 9, 2007

Last updated

Oct 9, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1191888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191888000000",
    "number": "1679761159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5830 W THUNDERBIRD RD STE B5",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853064655",
            "telephone_number": "602-841-7886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5830 W THUNDERBIRD RD STE B5",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853064655",
            "telephone_number": "602-841-7886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIT",
        "first_name": "BOBBY",
        "middle_name": "J",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-10-09",
        "last_updated": "2007-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "AZ",
            "license": "644",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Petkov Bodywork Therapy, LLC (AllOne Mobile Healthcare)
• Rumen Antoniev Petkov, OT
• Deborah Petri, LPC
• Sahar Petros, DMD
• Victoria Joan Petti, P.T.
• Ty Pfau, DO
• Laurie Pfeiffer, LPC
• Cindy Huong Thu Pham, D.M.D.
• Kieuanh T Pham, R.N.
• Michael Nhan Vo Pham, PHARMACIST

• Optician in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Optician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2007; 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.