Provider Demographics
NPI:1568631109
Name:STEPHEN A DITTA
Entity Type:Organization
Organization Name:STEPHEN A DITTA
Other - Org Name:TOMBALL VISION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DITTA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-351-7378
Mailing Address - Street 1:1231 ALMA
Mailing Address - Street 2:SUITE 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:SUITE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3624T332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0931360001Medicare NSC