Provider Demographics
NPI:1609978303
Name:PITHWA, NAINESH (OD)
Entity Type:Individual
Prefix:DR
First Name:NAINESH
Middle Name:
Last Name:PITHWA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:NEAL
Other - Middle Name:
Other - Last Name:PITHWA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1975 GLENN MITCHELL DR
Mailing Address - Street 2:104
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-0167
Mailing Address - Country:US
Mailing Address - Phone:757-368-3937
Mailing Address - Fax:757-516-7032
Practice Address - Street 1:1975 GLENN MITCHELL DR
Practice Address - Street 2:104
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-0167
Practice Address - Country:US
Practice Address - Phone:757-368-3937
Practice Address - Fax:757-516-7032
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2566152W00000X
GA2204152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1504386Medicaid
TN1504386Medicaid