Provider Demographics
NPI:1528060241
Name:KITTLEMAN, WILLIAM THOMAS (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:THOMAS
Last Name:KITTLEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2120 ROUND ROCK AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4010
Mailing Address - Country:US
Mailing Address - Phone:502-244-1991
Mailing Address - Fax:512-244-1786
Practice Address - Street 1:2120 ROUND ROCK AVE STE 100
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4010
Practice Address - Country:US
Practice Address - Phone:502-244-1991
Practice Address - Fax:512-244-1786
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF9675207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123221703Medicaid
TXB23999Medicare UPIN