MEDICARE: DR. TRENT JAMES PITT OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2464	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124104344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRENT JAMES PITT OD

Provider Business Mailing Address
First Line	:	3011 NW 63RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-3629
Country	:	US
Telephone Number	:	405-840-2800
Fax Number	:	405-840-8242

Provider Business Practice Location Address
First Line	:	3011 NW 63RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-3629
Country	:	US
Telephone Number	:	405-840-2800
Fax Number	:	405-840-8242

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	04/22/2008

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