| Doctor Name: | MR. WARREN A WITTIG |
| NPI Number: | 1205072519 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | OPTICIAN |
| License Number: | 1101000478 |
| Business Practice Address: | 215 Conicville Blvd Mount Jackson, VA - 228422862 |
| Business Phone Number: | 5404772526 |
| Business Fax Number: | 5404772527 |
| Mailing Address: | 215 Conicville Blvd, MOUNT JACKSON |
| State: | VA |
| Postal Code: | 228422862 |
| Phone Number: | 5404772526 |
| Fax Number: | 5404772527 |
| NPI Enumeration Date: | 12/17/2008 |
| NPI Last Update Date: | 12/17/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | 1101000478 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |