Provider Demographics
NPI:1447299904
Name:WITT, WILLIAM DEAN (MD, OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DEAN
Last Name:WITT
Suffix:
Gender:M
Credentials:MD, OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 COLLEGE AVE
Mailing Address - Street 2:BUILDING D SUITE 156
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2770
Mailing Address - Country:US
Mailing Address - Phone:785-537-3937
Mailing Address - Fax:785-537-2914
Practice Address - Street 1:1133 COLLEGE AVE
Practice Address - Street 2:BUILDING D SUITE 156
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2770
Practice Address - Country:US
Practice Address - Phone:785-537-3937
Practice Address - Fax:785-537-2914
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2318152W00000X
KS1588152W00000X
NE6489207W00000X
MO2007019126207W00000X
KS04-35632207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU81735Medicare UPIN