Individual
ALYSSA MACKENZIE CHILDERS-PITTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
530 E MAIN ST, PURCELLVILLE, VA 20132-3171
(540) 338-1833
Mailing address
530 E MAIN ST, PURCELLVILLE, VA 20132-3171
(540) 338-1833
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618002316
VA
152W00000X
Optometrist
1095-IOD
WV
152W00000X
Optometrist
6112
OH
152W00000X
Optometrist
OEG002638
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
VVE942A
MEDICARE PTAN
VA
Enumeration date
08/01/2012
Last updated
07/28/2015
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