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General NPI Number Information
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NPI Number | 1376385831
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Entity Type | Individual
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Provider Name | SHANE ROBERT WHITNEY OD
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Gender | Male
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Dates
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Enumeration Date | 06/06/2024
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Last Update Date | 07/21/2024
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Provider Practice Location Address
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Address Line | 3226 E COLONIAL DR
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City | ORLANDO
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State | FL
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Zip | 32803-5110
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Country | US
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Telephone | 407-203-5801
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Fax |
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Provider Business Mailing Address
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Address Line | 1885 JEWELL AVE APT 280
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City | WINTER PARK
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State | FL
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Zip | 32789-5585
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Country | US
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Telephone | 850-284-7742
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 6472
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License Number State | FL
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