IndividualActive
Carmine Petracca, OD
NPI 1457468613 · Optometrist · Lewiston, ID
Provider details
- NPI number
- 1457468613
- Entity type
- Individual
- Primary specialty
- OptometristEye and Vision Services Providers
- Credential
- OD
- Sex
- Male
- Sole proprietor
- No
- License
- ODP634 (ID)
Specialties & taxonomies
Eye and Vision Services Providers
Practice location
939 Bryden
Lewiston, ID 83501-5097
Phone: (208) 743-1761
Fax: (208) 746-8042
Approximate (ZIP-level) locationGet directions
Mailing address
939 Bryden
Lewiston, ID 83501-5097
Registry dates
- Enumerated
- 2006-08-24
- Last updated
- 2007-07-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.