Provider Demographics
NPI:1073653564
Name:DITTMAN EYECARE, INC.
Entity Type:Organization
Organization Name:DITTMAN EYECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-287-5739
Mailing Address - Street 1:156 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-4927
Mailing Address - Country:US
Mailing Address - Phone:724-287-5739
Mailing Address - Fax:
Practice Address - Street 1:156 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-4927
Practice Address - Country:US
Practice Address - Phone:724-287-5739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000002152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA9176313OtherDORAL
GAP00121665OtherPALMETTO GBA- RAILROAD MEDICARE
PA000000485BOtherUPMC
PA001815491OtherBLUE CROSS BLUE SHIELD
PA50093OtherDAVIS
PA50093OtherDAVIS
PA000000485BOtherUPMC
5106040001Medicare Oscar/Certification
PA50093OtherDAVIS
PA9176313OtherDORAL
PA5106040001Medicare Oscar/Certification