Provider Demographics
NPI:1033410014
Name:GERALD T PITTLER O. D. INC.
Entity Type:Organization
Organization Name:GERALD T PITTLER O. D. INC.
Other - Org Name:LAKEVILLE EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:T
Authorized Official - Last Name:PITTLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:707-763-1423
Mailing Address - Street 1:855 LAKEVILLE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-7327
Mailing Address - Country:US
Mailing Address - Phone:707-763-1423
Mailing Address - Fax:707-981-4582
Practice Address - Street 1:855 LAKEVILLE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-7327
Practice Address - Country:US
Practice Address - Phone:707-763-1423
Practice Address - Fax:707-981-4582
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GERALD T PITTLER O. D. INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-08
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6321152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEA573AMedicare PIN
CAT10290Medicare UPIN