Provider Demographics
NPI:1972636256
Name:HITTLE, LAWRENCE IDEN (OD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:IDEN
Last Name:HITTLE
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 1:414 ELM ST S
Mailing Address - Street 2:
Mailing Address - City:SAUK CENTRE
Mailing Address - State:MN
Mailing Address - Zip Code:56378-1416
Mailing Address - Country:US
Mailing Address - Phone:320-352-7876
Mailing Address - Fax:
Practice Address - Street 1:205 12TH ST S
Practice Address - Street 2:
Practice Address - City:SAUK CENTRE
Practice Address - State:MN
Practice Address - Zip Code:56378-1614
Practice Address - Country:US
Practice Address - Phone:320-352-0146
Practice Address - Fax:320-352-0023
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3089152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist