Individual
PAUL R DEWITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
US HWY 160 & NAVAJO ROUTE 35 - RED MESA, TEECNOSPOS, AZ 86514
(928) 656-5000
Mailing address
HC 61 BOX 30, TEEC NOS POS, AZ 86514-9600
(928) 656-5000
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2320
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65837533
—
NM
05
—
796063
—
AZ
Enumeration date
07/07/2006
Last updated
12/06/2019
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