Provider Demographics
NPI:1063095339
Name:NITTMANN, MATHIAS
Entity type:Individual
Prefix:
First Name:MATHIAS
Middle Name:
Last Name:NITTMANN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 W CARMEN ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-0030
Mailing Address - Country:US
Mailing Address - Phone:978-844-1351
Mailing Address - Fax:
Practice Address - Street 1:17 DAVID BLVD.
Practice Address - Street 2:#308
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606
Practice Address - Country:US
Practice Address - Phone:813-974-2201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
DCMD600003946207WX0110X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program