Provider Demographics
NPI:1114460193
Name:WITTMANN, AMY LYNNE (OD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNNE
Last Name:WITTMANN
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6217 SYLVANIA WAY
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-4926
Mailing Address - Country:US
Mailing Address - Phone:915-526-7418
Mailing Address - Fax:
Practice Address - Street 1:12236 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-4851
Practice Address - Country:US
Practice Address - Phone:915-213-3410
Practice Address - Fax:915-226-0510
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-23
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9125TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty