Provider Demographics
NPI:1487645552
Name:DITTA, STEPHEN A (OD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:DITTA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1231 ALMA ST
Mailing Address - Street 2:STE O
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4501
Mailing Address - Country:US
Mailing Address - Phone:281-351-7378
Mailing Address - Fax:281-255-9597
Practice Address - Street 1:1231 ALMA ST
Practice Address - Street 2:STE O
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4501
Practice Address - Country:US
Practice Address - Phone:281-351-7378
Practice Address - Fax:281-255-9597
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX3624T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX760194385OtherCOMP BENEFITS
TX760194385OtherSUPERIOR VISION
TX2813517378OtherVISION SERVICE PLAN
TX093346701Medicaid
TX930127OtherBLOCK VISION
TX760194385OtherEYEMED
TX2813517378OtherVISION SERVICE PLAN
TX093346701Medicaid