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NPI Code Detail

MEDICARE: DR. KEVIN A. WHITELEATHER OD

MEDICARE: DR. KEVIN A. WHITELEATHER OD
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
1152W00000XOptometrist18003140AIN
2152WL0500XLow Vision Rehabilitation Optometrist18003140AIN
3152WC0802XCorneal and Contact Management Optometrist18003140AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17470288OTHERINAETNA PROVIDER NUMBER
2000000225758OTHERINANTHEM BC/BS PROVIDER NO.

General Provider Information

NPI Number : 1497758395
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEVIN A. WHITELEATHER OD
Provider Business Mailing Address
First Line : 4201 LAHMEYER RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46815-5676
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4201 LAHMEYER RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46815-5676
Country : US
Telephone Number : 260-486-6106
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 10/26/2007

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