=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871663195
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEFFREY C PITTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2006
-----------------------------------------------------
Last Update Date | 10/22/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 269 SW 19TH ST
-----------------------------------------------------
City | ONTARIO
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97914-1972
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-889-3106
-----------------------------------------------------
Fax | 541-889-3904
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 269 SW 19TH ST
-----------------------------------------------------
City | ONTARIO
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97914-1972
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-889-3106
-----------------------------------------------------
Fax | 541-889-3904
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER MANAGER SOLE PROPRIETOR
-----------------------------------------------------
Name | DR. JEFFREY C PITTS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 541-889-3106
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 13467
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------