Healthcare Provider Details

I. General information

NPI: 1982686341
Provider Name (Legal Business Name): JOHN C WHITING OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 BOYDEN RD
HOLDEN MA
01520-2570
US

IV. Provider business mailing address

5 NEPONSET ST FL STREET12
WORCESTER MA
01606-2714
US

V. Phone/Fax

Practice location:
  • Phone: 508-856-9599
  • Fax: 508-829-4988
Mailing address:
  • Phone: 978-345-7398
  • Fax: 978-353-0035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3146
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: