Provider Demographics
NPI:1033908900
Name:PITTSER, BLAKE (OD)
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:
Last Name:PITTSER
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 1:808 DECKER DR
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-3964
Mailing Address - Country:US
Mailing Address - Phone:740-463-9898
Mailing Address - Fax:
Practice Address - Street 1:87 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-8941
Practice Address - Country:US
Practice Address - Phone:937-382-2433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.007382152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist