Dale L Wittkop, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

49010003042 Issued in MI

Practice address

123 Locust St
Allegan, MI 49010-1301

Phone

(269) 673-5100

Fax

(269) 673-1806

NPI assigned

Jun 27, 2005

Last updated

Feb 14, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1119830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329177600000",
    "number": "1447256136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 LOCUST ST",
            "city": "ALLEGAN",
            "state": "MI",
            "postal_code": "490101301",
            "telephone_number": "269-673-5100",
            "fax_number": "269-673-1806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 LOCUST ST",
            "city": "ALLEGAN",
            "state": "MI",
            "postal_code": "490101301",
            "telephone_number": "269-673-5100",
            "fax_number": "269-673-1806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITTKOP",
        "first_name": "DALE",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-27",
        "last_updated": "2012-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "49010003042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MICHIGAN",
            "identifier": "900Z310140",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MICHIGAN",
            "identifier": "900Z365250",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "944193774",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Camille Williams
• Shawna Ray Wilson, CPHT
• Terry Lee Wing, LMSW (MACRO)
• Wings of Hope Hospice and Palliative Care Inc. (Journeys Advanced Illness Management)
• Wings of Hope Hospice and Palliative Care, Inc.
• Rebecca Wolfe, BA
• Heather Lynn Wright, M.D.
• Megan E Wszolek, LMSW
• Candas Ziemba, MA
• Amber Leigh Zimmer, BBA

• Optometrist in Allegan, MI
• Providers in Allegan, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.