Provider Demographics
NPI:1013909415
Name:STITES, CARL LOUIS (OD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:LOUIS
Last Name:STITES
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 1:6840 NORTHWAY DR NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-7568
Mailing Address - Country:US
Mailing Address - Phone:616-863-2020
Mailing Address - Fax:
Practice Address - Street 1:6840 NORTHWAY DR NE
Practice Address - Street 2:SUITE A
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-7568
Practice Address - Country:US
Practice Address - Phone:616-863-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003291152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900D117550OtherBCBSM
MI0N96080Medicare PIN
MI900D117550OtherBCBSM