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PAUL R DEWITT OD

>> Optometrist >> Eye and Vision Services Providers

Registrant NPI Number: 1366474207

Individual Registrant:
 PAUL R DEWITT OD
Gender: M
Not Sole Proprietor

Location and contact information for practice:
HWY 160 MP 394.3  KAYENTA, AZ 86033-0368 US
Tel: 928-697-4000  Fax: 928-697-4145

Contact information for business:
PO BOX 368  KAYENTA, AZ 86033-0368 US
Tel: 928-697-4000  Fax: 928-697-4145

Registration Information:
NPI: 1366474207
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y152W00000XEye and Vision Services Providers
Optometrist
CO2320

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
796063AZ05
65837533NM05




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