Provider Demographics
NPI:1033596127
Name:WHITNEY, JEREMY THOMAS (OD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:THOMAS
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 1:150 DORSET ST
Mailing Address - Street 2:STE 250
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6238
Mailing Address - Country:US
Mailing Address - Phone:802-497-0338
Mailing Address - Fax:
Practice Address - Street 1:150 DORSET ST STE 250
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6238
Practice Address - Country:US
Practice Address - Phone:802-497-0338
Practice Address - Fax:802-497-2963
Is Sole Proprietor?:No
Enumeration Date:2015-04-28
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT030-0133940152W00000X
MDTA2421152W00000X
VT030-133940152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty