Provider Demographics
NPI:1538127956
Name:PITTALUGA, MARK WILIIAM
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:WILIIAM
Last Name:PITTALUGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5499 N FEDERAL HWY
Mailing Address - Street 2:SUITE E
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487
Mailing Address - Country:US
Mailing Address - Phone:561-988-0300
Mailing Address - Fax:561-988-0350
Practice Address - Street 1:5499 N FEDERAL HWY
Practice Address - Street 2:SUITE E
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-4993
Practice Address - Country:US
Practice Address - Phone:561-988-0300
Practice Address - Fax:561-988-0350
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2886152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5619880300OtherVSP
FL28370OtherSPECTERA
FL50187OtherDAVIS VISION
FL5619880300OtherCOMPBENEFITS
FL620863100Medicaid
FL87726OtherUNITED HEALTH CARE
FLFL2886OtherEYE MED
FL620863100Medicaid