Healthcare Provider Details

I. General information

NPI: 1134414709
Provider Name (Legal Business Name): DEREK P BITNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2011
Last Update Date: 02/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 WESTOWN PKWY
WEST DES MOINES IA
50266-7705
US

IV. Provider business mailing address

309 E CHURCH ST
MARSHALLTOWN IA
50158-2946
US

V. Phone/Fax

Practice location:
  • Phone: 515-223-8685
  • Fax: 515-223-5468
Mailing address:
  • Phone: 641-754-6200
  • Fax: 641-754-6245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD-43354
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License NumberMD-43354
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: