Provider Demographics
NPI:1184671174
Name:DITTOE, ROBERT J (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:DITTOE
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 1:449 BUCKINGHAM LN
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8891
Mailing Address - Country:US
Mailing Address - Phone:740-681-9680
Mailing Address - Fax:
Practice Address - Street 1:391 LINCOLN PARK DR
Practice Address - Street 2:
Practice Address - City:NEW LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:43764-1080
Practice Address - Country:US
Practice Address - Phone:740-342-1784
Practice Address - Fax:740-342-1791
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3465/T409152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH580002099AOtherRAILROAD MEDICARE
OH0429656Medicaid
OH0486763Medicare PIN
OH0174910001Medicare NSC
OHT47216Medicare UPIN