Provider Demographics
NPI:1669833463
Name:GREGORY L BITTNER OD LLC
Entity Type:Organization
Organization Name:GREGORY L BITTNER OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BITTNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:814-445-6664
Mailing Address - Street 1:268 W UNION ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-1539
Mailing Address - Country:US
Mailing Address - Phone:814-445-6664
Mailing Address - Fax:814-443-1108
Practice Address - Street 1:268 W UNION ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-1539
Practice Address - Country:US
Practice Address - Phone:814-445-6664
Practice Address - Fax:814-443-1108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000649152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty