Provider Demographics
NPI:1841282910
Name:MITTER, ROBERT R (OD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:R
Last Name:MITTER
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 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:866-795-4020
Practice Address - Street 1:506 N CENTRE ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2103
Practice Address - Country:US
Practice Address - Phone:301-722-6480
Practice Address - Fax:301-722-6297
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2018-01-31
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
MDTA0730152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD409BEYOtherBLUE CROSS BLUE SHIELD
MD76344800Medicaid
MD76344800Medicaid
MD638LMedicare ID - Type Unspecified