Provider Demographics
NPI:1033128145
Name:TITTL, STEVEN PAUL DOUGLAS (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:PAUL DOUGLAS
Last Name:TITTL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34380 GLEN DR
Mailing Address - Street 2:
Mailing Address - City:EASTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44095-2610
Mailing Address - Country:US
Mailing Address - Phone:617-549-9744
Mailing Address - Fax:
Practice Address - Street 1:1000 WEST AVE
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-4759
Practice Address - Country:US
Practice Address - Phone:888-401-4884
Practice Address - Fax:888-401-4884
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4238152W00000X
OHOPT.006835152W00000X
AKOD5494152W00000X
FLOPC5988152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW17148Medicare UPIN
AKK162269Medicare PIN