Provider Demographics
NPI:1417935156
Name:PITTENGER, WILLIAM FOUNTAINE JR (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:FOUNTAINE
Last Name:PITTENGER
Suffix:JR
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 1:806 REGAL DR
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801
Mailing Address - Country:US
Mailing Address - Phone:256-536-4489
Mailing Address - Fax:256-536-4399
Practice Address - Street 1:806 REGAL DR
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801
Practice Address - Country:US
Practice Address - Phone:256-536-4489
Practice Address - Fax:256-536-4399
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS520TA073152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL59771Medicare ID - Type Unspecified
T69027Medicare UPIN