Individual provider Active NPI

Amy Lynne Wittmann, O.D.

  • Optometrist
  • El Paso, TX
National Provider Identifier
1114460193
Registry record updated Jul 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
9125TG Issued in TX
Practice address
12236 Montana Ave
El Paso, TX 79938-4851
Phone
(915) 213-3410
Fax
(915) 226-0510
NPI assigned
Nov 23, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 9125TG TX Primary

Addresses

Primary practice location

12236 Montana Ave
El Paso, TX 79938-4851

Mailing address

6217 Sylvania Way
El Paso, TX 79912-4926
Phone (915) 526-7418

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170126001876 TX Practitioner - Optometry 8527340579 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9125TXMDOrthodontics and Dentofacial Orthopedic Dentist
9125TGTXMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Aeg Texas Professional PLLC Optometrist CurrentSince Jan 2, 2021 Accepting new patients
Wittmann Vision, PLLC Optometrist CurrentSince Apr 18, 2023 Accepting new patients

Locations

4775 Loma del Sur Dr
El Paso, TX 79934
Phone (512) 889-2020

12236 Montana Ave
El Paso, TX 79938
Phone (915) 213-3410

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1479859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751932800000",
    "number": "1114460193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6217 SYLVANIA WAY",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799124926",
            "telephone_number": "915-526-7418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12236 MONTANA AVE",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799384851",
            "telephone_number": "915-213-3410",
            "fax_number": "915-226-0510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITTMANN",
        "first_name": "AMY",
        "middle_name": "LYNNE",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-11-23",
        "last_updated": "2025-07-08",
        "certification_date": "2025-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "TX",
            "license": "9125TG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in El Paso, TX

Sources for this page

Verify at the official NPI Registry.