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General NPI Number Information
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NPI Number | 1538240791
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Entity Type | Individual
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Provider Name | DIRK A DITTEMORE O.D.
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Gender | Male
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 1025 W 6TH ST
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City | JUNCTION CITY
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State | KS
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Zip | 66441-3230
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Country | US
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Telephone | 852-235-7777
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Fax | 785-223-0257
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Provider Business Mailing Address
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Address Line | 550 POPE AVE OPTOMETRY CLINIC
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City | FORT LEAVENWORTH
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State | KS
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Zip | 66027-2332
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Country | US
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Telephone | 913-684-6750
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1348
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License Number State | KS
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