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General NPI Number Information
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NPI Number | 1770712051
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Entity Type | Organization
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Legal Business Name | LAWRENCE I. HITTLE, O.D., P.A.
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Dates
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Enumeration Date | 07/08/2009
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Last Update Date | 09/21/2009
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Provider Practice Location Address
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Address Line | 205 12TH ST S
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City | SAUK CENTRE
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State | MN
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Zip | 56378-1614
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Country | US
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Telephone | 320-352-0146
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Fax | 320-352-0023
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Provider Business Mailing Address
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Address Line | 205 12TH ST S
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City | SAUK CENTRE
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State | MN
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Zip | 56378-1614
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Country | US
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Telephone | 320-352-0146
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Fax | 320-352-0023
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LAWRENCE I HITTLE
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Credential | O.D.
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Telephone | 208-283-4342
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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 | 3089
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License Number State | MN
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