Provider Demographics
NPI:1912914417
Name:PITTMAN, WESLEY E (OD)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:E
Last Name:PITTMAN
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:PO BOX 590
Mailing Address - Street 2:
Mailing Address - City:MEXIA
Mailing Address - State:TX
Mailing Address - Zip Code:76667-0590
Mailing Address - Country:US
Mailing Address - Phone:254-562-3883
Mailing Address - Fax:254-562-2341
Practice Address - Street 1:501 E MILAM ST
Practice Address - Street 2:
Practice Address - City:MEXIA
Practice Address - State:TX
Practice Address - Zip Code:76667-2331
Practice Address - Country:US
Practice Address - Phone:254-562-3883
Practice Address - Fax:254-562-2341
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3380TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093150303Medicaid
TXP00325271OtherRAILROAD MEDICARE
TXP00325271OtherRAILROAD MEDICARE
8B1300Medicare ID - Type Unspecified