Provider Demographics
NPI:1477539104
Name:BITTNER, GREGORY L (OD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:L
Last Name:BITTNER
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 1:268 W UNION ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-1539
Mailing Address - Country:US
Mailing Address - Phone:814-445-6664
Mailing Address - Fax:814-443-1108
Practice Address - Street 1:268 W UNION ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-1539
Practice Address - Country:US
Practice Address - Phone:814-445-6664
Practice Address - Fax:814-443-1108
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000649152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT28599Medicare UPIN
PA0659790001Medicare NSC