Provider Demographics
NPI:1497071690
Name:B J PITTMAN OD PA
Entity type:Organization
Organization Name:B J PITTMAN OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR.
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADDI
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-626-0943
Mailing Address - Street 1:1713 INDIAN MOON CV
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-3396
Mailing Address - Country:US
Mailing Address - Phone:830-626-0943
Mailing Address - Fax:830-626-0943
Practice Address - Street 1:62 N CAMERON ST
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4953
Practice Address - Country:US
Practice Address - Phone:361-664-3571
Practice Address - Fax:361-664-3502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-13
Last Update Date:2018-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2241TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121630103Medicaid
TXT15313Medicare UPIN
TX121630103Medicaid
TX4133390001Medicare NSC