Provider Demographics
NPI:1568716033
Name:CHARLES BITTEL III, O.D., INC.
Entity Type:Organization
Organization Name:CHARLES BITTEL III, O.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BITTEL
Authorized Official - Suffix:III
Authorized Official - Credentials:OD
Authorized Official - Phone:714-779-8521
Mailing Address - Street 1:20399 YORBA LINDA BLVD
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-3062
Mailing Address - Country:US
Mailing Address - Phone:714-779-8521
Mailing Address - Fax:714-779-8581
Practice Address - Street 1:20399 YORBA LINDA BLVD
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-3062
Practice Address - Country:US
Practice Address - Phone:714-779-8521
Practice Address - Fax:714-779-8581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-05
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT13002T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA545AMedicare PIN