Healthcare Provider Details

I. General information

NPI: 1265548531
Provider Name (Legal Business Name): BENJAMIN HAROLD WHITLING O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 04/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21920 ROUTE 119
PUNXSUTAWNEY PA
15767-7975
US

IV. Provider business mailing address

447 JARED ST
BROOKVILLE PA
15825-1190
US

V. Phone/Fax

Practice location:
  • Phone: 814-938-9100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG001813
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: