Provider Demographics
NPI:1134209646
Name:HITTINGER, NORMAN JAY JR (OD)
Entity type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:JAY
Last Name:HITTINGER
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:605 TAMENEND CT
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-4222
Mailing Address - Country:US
Mailing Address - Phone:317-842-8570
Mailing Address - Fax:
Practice Address - Street 1:2320 S TIBBS AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-4801
Practice Address - Country:US
Practice Address - Phone:317-241-2019
Practice Address - Fax:317-487-2182
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001862B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU30900Medicare UPIN