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NPI Code Detail

MEDICARE: DR. LARRY A WHETSTINE O.D.

MEDICARE: DR. LARRY A WHETSTINE 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
1152W00000XOptometrist04598TTX

General Provider Information

NPI Number : 1295765915
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LARRY A WHETSTINE O.D.
Provider Business Mailing Address
First Line : 7108 CAMP BOWIE BLVD
Second Line :
City : FORT WORTH
State : TX
Zip : 76116-7121
Country : US
Telephone Number : 817-738-3191
Fax Number : 817-738-7724
Provider Business Practice Location Address
First Line : 7108 CAMP BOWIE BLVD
Second Line :
City : FORT WORTH
State : TX
Zip : 76116-7121
Country : US
Telephone Number : 817-738-3191
Fax Number : 817-738-7724
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2006
Last Update Date : 12/21/2007

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