Provider Demographics
NPI:1003848615
Name:WHITWORTH, PATRICK GLADE (OD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:GLADE
Last Name:WHITWORTH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19045 E VALLEY VIEW PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-7030
Mailing Address - Country:US
Mailing Address - Phone:816-795-7777
Mailing Address - Fax:816-795-1290
Practice Address - Street 1:19045 E VALLEY VIEW PKWY
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-7030
Practice Address - Country:US
Practice Address - Phone:816-795-7777
Practice Address - Fax:816-795-1290
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO3371152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP128155Medicare ID - Type Unspecified
MOU68919Medicare UPIN