Provider Demographics
NPI:1003980483
Name:WHITNEY, DAVID BLAIR (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BLAIR
Last Name:WHITNEY
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 1:16930 BLACK WALNUT LN
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-9656
Mailing Address - Country:US
Mailing Address - Phone:517-575-0560
Mailing Address - Fax:
Practice Address - Street 1:340 E EDGEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-5807
Practice Address - Country:US
Practice Address - Phone:517-887-0015
Practice Address - Fax:517-887-0233
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002776152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist