Provider Demographics
NPI:1063571743
Name:PITTARAS, BARBARA (OD)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:PITTARAS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 OAK LEE DR
Mailing Address - Street 2:SUITE 12B
Mailing Address - City:RANSON
Mailing Address - State:WV
Mailing Address - Zip Code:25438-4871
Mailing Address - Country:US
Mailing Address - Phone:304-724-2025
Mailing Address - Fax:304-724-2024
Practice Address - Street 1:217 OAK LEE DR
Practice Address - Street 2:SUITE 12B
Practice Address - City:RANSON
Practice Address - State:WV
Practice Address - Zip Code:25438-4871
Practice Address - Country:US
Practice Address - Phone:304-724-2025
Practice Address - Fax:304-724-2024
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1819152W00000X
WV1021-OD152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU90885Medicare UPIN
WVA852Medicare PIN