Provider Demographics
NPI:1457308793
Name:BITTNER, AVA (OD)
Entity Type:Individual
Prefix:
First Name:AVA
Middle Name:
Last Name:BITTNER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:AVA
Other - Middle Name:
Other - Last Name:KISER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 STEIN PLZ
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0005
Practice Address - Country:US
Practice Address - Phone:310-825-3090
Practice Address - Fax:310-206-5673
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34143152WL0500X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD361002100Medicaid
MDKR84E103Medicare PIN
MD361002100Medicaid