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General NPI Number Information
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NPI Number | 1497071690
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Entity Type | Organization
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Legal Business Name | B J PITTMAN OD PA
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Dates
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Enumeration Date | 04/13/2010
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Last Update Date | 12/15/2018
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Provider Practice Location Address
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Address Line | 62 N CAMERON ST
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City | ALICE
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State | TX
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Zip | 78332-4953
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Country | US
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Telephone | 361-664-3571
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Fax | 361-664-3502
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Provider Business Mailing Address
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Address Line | 1713 INDIAN MOON CV
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City | NEW BRAUNFELS
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State | TX
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Zip | 78132-3396
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Country | US
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Telephone | 830-626-0943
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Fax | 830-626-0943
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Authorized Official
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Title or Position | OFFICE MGR.
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Name | MRS. ADDI PITTMAN
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Credential |
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Telephone | 830-626-0943
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2241TG
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License Number State | TX
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