Provider Demographics
NPI:1225602592
Name:WHITEHAIR, COLLIN J I
Entity Type:Individual
Prefix:
First Name:COLLIN
Middle Name:J
Last Name:WHITEHAIR
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 S CAMINO DEL RIO
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-6698
Mailing Address - Country:US
Mailing Address - Phone:970-259-8755
Mailing Address - Fax:
Practice Address - Street 1:1155 S CAMINO DEL RIO
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-6698
Practice Address - Country:US
Practice Address - Phone:970-259-8755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician