Provider Demographics
NPI:1033209192
Name:VITITOW, ROBERT ANDREW (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ANDREW
Last Name:VITITOW
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 1:43 DAVIS STREET
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4239
Mailing Address - Country:US
Mailing Address - Phone:607-722-3747
Mailing Address - Fax:607-722-3747
Practice Address - Street 1:2441 VESTAL PARKWAY EAST
Practice Address - Street 2:SAM'S CLUB
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2018
Practice Address - Country:US
Practice Address - Phone:607-770-6297
Practice Address - Fax:607-766-8592
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT006050152WC0802X
NYTUV006050152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000127034OtherBLUE CROSS BLUE SHIELD
NY40910OtherSPECTERA
NY93653OtherDAVIS VISION
NY40910OtherSPECTERA
V07976Medicare UPIN