CARMINE PETRACCA (NPI# 1649601006) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649601006 |
| Entity Type | Organization |
| Organization Name | CARMINE PETRACCA |
| Other Organization Name | BRYDEN FAMILY VISION |
| Practice Address |
939 Bryden Ave Lewiston ID 83501-5057 |
| Practice Telephone | 2087431761 |
| Practice Fax Number | 2087468042 |
| Mailing Telephone | 2087431761 |
| Mailing Fax Number | 2087468042 |
| Enumeration Date | 2013-12-10 |
| Last Update Date | 2013-12-10 |
| Authorized Official Name | DR. CARMINE PETRACCA (OWNER) |
| Authorized Official Telephone | 2087431761 |
| Authorized Official Credential | O.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QH0100X |
Clinic/Center Specialization: Health Service |
ODP-634 | ID | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Bryden Family Vision | Doing Business As Name - Organization |
| Street Address |
939 BRYDEN AVE |
| City | LEWISTON |
| State | ID |
| Zip Code | 83501-5057 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013910371 | James E Pierce | Dentist | 939 Bryden Ave, #2, Lewiston, ID 83501-5057 | 2005-05-31 |
| 1750947925 | Two Rivers Family & Cosmetic Dentistry, Pa | Clinic/Center | 939 Bryden Ave, Lewiston, ID 83501-5057 | 2019-05-14 |
| 1558752204 | Bryden Family Vision | Optometrist | 939 Bryden Ave, Lewiston, ID 83501-5057 | 2015-02-16 |
| 1588071633 | Jason Scott Ritter | Optometrist | 939 Bryden Ave, Lewiston, ID 83501-5057 | 2014-07-21 |
| 1932119161 | Randy L. Sorensen Dmd Pa | Dentist | 939 Bryden Ave, Lewiston, ID 83501-5057 | 2006-08-09 |
| 1124037924 | Randy Lee Sorensen | Dentist | 939 Bryden Ave, Lewiston, ID 83501-5057 | 2006-08-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679193759 | Jacqueline M Aldrich | Behavior Technician | 3407 12th Street C, 3407 12th Street C, Lewiston, ID 83501 | 2020-04-20 |
| 1295228054 | Provident Foundation - Wedgewood Terrace LLC | Alzheimer Center (Dementia Center) | 2114 Vineyard Avenue, Lewiston, ID 83501 | 2018-06-07 |
| 1164945325 | Xiaofei Liu | Massage Therapist | 234 Thain Rd, Lewiston, ID 83501 | 2017-07-19 |
| 1467909879 | Sharon Thulon | Registered Nurse | 1118 F Street, Lewiston, ID 83501 | 2016-09-01 |
| 1821459496 | Gem State Endoscopy | Clinic/Center | 3709 14th Street, Lewiston, ID 83501 | 2016-03-10 |
| 1508264995 | Gary L. Grogan | Psychologist | 633 Main Street, B#1, Lewiston, ID 83501 | 2014-12-17 |
| 1003189366 | John Joseph Johnson | Dentist | 3510 12th Street, Suite #600, Lewiston, ID 83501 | 2012-02-17 |
| 1306134077 | Rowena Kathryn Jackson | Counselor | 531 Bryden Avenue, Lewiston, ID 83501 | 2011-07-15 |
| 1912290388 | Staci Leanne Truby | Massage Therapist | 717 'd' Street, Lewiston, ID 83501 | 2011-05-18 |
| 1093040685 | Sharie Ann Uhlorn | Registered Nurse | 1837 Alder Court, Lewiston, ID 83501 | 2009-10-15 |
| Find all providers in zip 83501 | ||||
| Taxonomy Code | 261QH0100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Health Service |
| Definition to come... |
| Notes: [7/1/2006: modified title] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588826036 | Chandra Sasseville Dc Pa | Clinic/Center | 416 Sabattus St, Lewiston, ME 04240-5430 | 2008-06-26 |
| 1679890800 | Western Maine Community Action | Clinic/Center | 179 Lisbon St, Lewiston, ME 04240-7248 | 2010-04-28 |
| 1447402987 | Concentra Health Services, Inc. | Clinic/Center | 59 East Ave., Lewiston, ME 04240-5667 | 2008-10-15 |
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| 1023639622 | Idaho Street Medical Clinic | Clinic/Center | 126 W. Idaho Ave, Homedale, ID 83628-8362 | 2020-05-05 |
| 1316506413 | Sawtooth Family Medicine Pllc | Clinic/Center | 2320 E Gala St Ste 400, Meridian, ID 83642-4880 | 2019-06-12 |
| 1770059792 | New Plymouth Clinic | Clinic/Center | 213 N Plymouth Ave, New Plymouth, ID 83655-5532 | 2018-10-17 |
| 1477044543 | Place of Food | Clinic/Center | 1131 Cole St, Kimberly, ID 83341-5138 | 2018-05-24 |
| 1619351582 | Natural Family Health Inc. | Clinic/Center | 945 E River Spur, Priest River, ID 83856-5070 | 2015-07-10 |
| 1982026571 | Treasure Valley Family Health Care, LLC | Clinic/Center | 1055 N Echohawk Way, Eagle, ID 83616-5456 | 2014-01-16 |
| 1124303094 | N.e.x.t. Level Health Center, Inc. | Clinic/Center | 2105 Niagara, Idaho Falls, ID 83404 | 2011-10-11 |
| 1972821254 | Sohm Chiropractic Pa | Clinic/Center | 8382 W Ustick Rd, Suite 200, Boise, ID 83704-5986 | 2010-05-11 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.