Provider Demographics
NPI:1770712051
Name:LAWRENCE I. HITTLE, O.D., P.A.
Entity type:Organization
Organization Name:LAWRENCE I. HITTLE, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:I
Authorized Official - Last Name:HITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-283-4342
Mailing Address - Street 1:205 12TH ST S
Mailing Address - Street 2:
Mailing Address - City:SAUK CENTRE
Mailing Address - State:MN
Mailing Address - Zip Code:56378-1614
Mailing Address - Country:US
Mailing Address - Phone:320-352-0146
Mailing Address - Fax:320-352-0023
Practice Address - Street 1:205 12TH ST S
Practice Address - Street 2:
Practice Address - City:SAUK CENTRE
Practice Address - State:MN
Practice Address - Zip Code:56378-1614
Practice Address - Country:US
Practice Address - Phone:320-352-0146
Practice Address - Fax:320-352-0023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-08
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3089152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN714467000OtherMINNESOTA HEALTH CARE PROGRAMS
MN01052855OtherPREFERRED ONE
MN0AY76LAOtherBCBSMN
MN2204671OtherMEDICA
MN0AY76LAOtherBCBSMN
MN410002641Medicare UPIN