Provider Demographics
NPI:1306925672
Name:JASON PITTSER OD INC.
Entity type:Organization
Organization Name:JASON PITTSER OD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE REP
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-382-2433
Mailing Address - Street 1:87 FAIRWAY DR
Mailing Address - Street 2:#125
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177
Mailing Address - Country:US
Mailing Address - Phone:937-382-2433
Mailing Address - Fax:937-383-6619
Practice Address - Street 1:87 FAIRWAY DR
Practice Address - Street 2:#125
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177
Practice Address - Country:US
Practice Address - Phone:937-382-2433
Practice Address - Fax:937-383-6619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5143152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U81256Medicare UPIN
OH4973970001Medicare NSC
OHDD9005Medicare PIN
OH9340871Medicare PIN