Provider Demographics
NPI:1346364908
Name:SITTO, DINA J (OPTICION)
Entity Type:Individual
Prefix:PROF
First Name:DINA
Middle Name:J
Last Name:SITTO
Suffix:
Gender:F
Credentials:OPTICION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2943 E BIG BEAVER RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-2467
Mailing Address - Country:US
Mailing Address - Phone:248-689-0213
Mailing Address - Fax:248-689-8854
Practice Address - Street 1:2943 E BIG BEAVER RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-2467
Practice Address - Country:US
Practice Address - Phone:248-689-0213
Practice Address - Fax:248-689-8854
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI88109156FX1202X
CA002906156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered156FX1202XEye and Vision Services ProvidersTechnician/TechnologistOptometric Technician
Not Answered156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP1875OtherEYEMED INSURANCE