MEDICARE: DR. NATHAN A WHITAKER O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	S825TA134	AL

General Provider Information

NPI Number	:	1053399592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHAN A WHITAKER O.D.

Provider Business Mailing Address
First Line	:	3701 LOOP RD
Second Line	:	TUSCALOOSA VAMC
City	:	TUSCALOOSA
State	:	AL
Zip	:	35404-5015
Country	:	US
Telephone Number	:	205-554-2822
Fax Number	:

Provider Business Practice Location Address
First Line	:	3701 LOOP RD
Second Line	:	TUSCALOOSA VAMC
City	:	TUSCALOOSA
State	:	AL
Zip	:	35404-5015
Country	:	US
Telephone Number	:	205-554-2822
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	11/26/2012

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