Provider Demographics
NPI:1619060373
Name:BILLITZ, MICHAEL STEPHEN (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:STEPHEN
Last Name:BILLITZ
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 1:7048 SHADY OAKS LANE
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173
Mailing Address - Country:US
Mailing Address - Phone:205-821-0913
Mailing Address - Fax:205-655-1680
Practice Address - Street 1:5919 TRUSSVILLE CROSSINGS PARKWAY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235
Practice Address - Country:US
Practice Address - Phone:205-661-1975
Practice Address - Fax:205-661-1977
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS919TA498152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51534076OtherBLUE CROSS BLUE SHEILD
AL51507228BILOtherBLUE CROSS BLUE SHEILD
AL51534076OtherBLUE CROSS BLUE SHEILD