Provider Demographics
NPI:1508941709
Name:BITTAR, FADEE MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:FADEE
Middle Name:MICHAEL
Last Name:BITTAR
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 1:1116 PATRICK LN
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-3157
Mailing Address - Country:US
Mailing Address - Phone:757-814-5625
Mailing Address - Fax:
Practice Address - Street 1:19 HIDENWOOD SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2200
Practice Address - Country:US
Practice Address - Phone:757-324-3952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001533152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010210259Medicaid
VA009047N84Medicare ID - Type Unspecified