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Individual

DR. DALE L WITTKOP

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
123 LOCUST ST, ALLEGAN, MI 49010-1301
(269) 673-5100
(269) 673-1806
Mailing address
123 LOCUST ST, ALLEGAN, MI 49010-1301
(269) 673-5100
(269) 673-1806

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
49010003042
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
900Z310140
BCBS OF MICHIGAN
01
900Z365250
BCBS OF MICHIGAN
MI
05
944193774
MI
Enumeration date
06/27/2005
Last updated
02/14/2012
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