Basic Information
| Provider Information | |||||||||
| NPI: | 1457308793 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BITTNER | ||||||||
| FirstName: | AVA | ||||||||
| MiddleName: | |||||||||
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| Credential: | O.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | KISER | ||||||||
| OtherFirstName: | AVA | ||||||||
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| OtherCredential: | O.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5767 W CENTURY BLVD STE 400 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900455631 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 STEIN PLZ | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900950005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108253090 | ||||||||
| FaxNumber: | 3102065673 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2006 | ||||||||
| LastUpdateDate: | 10/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152WL0500X | 34143 | CA | N | Eye and Vision Services Providers | Optometrist | Low Vision Rehabilitation | 152W00000X | 34143 | CA | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 361002100 | 05 | MD | MEDICAID |