Provider Demographics
NPI:1124104344
Name:PITT, TRENT JAMES (OD)
Entity type:Individual
Prefix:DR
First Name:TRENT
Middle Name:JAMES
Last Name:PITT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 NW 63RD ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-3629
Mailing Address - Country:US
Mailing Address - Phone:405-840-2800
Mailing Address - Fax:405-840-8242
Practice Address - Street 1:3011 NW 63RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-3629
Practice Address - Country:US
Practice Address - Phone:405-840-2800
Practice Address - Fax:405-840-8242
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2464152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200062890AMedicaid
V07873Medicare UPIN
249601101Medicare ID - Type Unspecified