Provider Demographics
NPI:1376299040
Name:WHATLEY, ELIZA MARGUERITE (OD)
Entity Type:Individual
Prefix:DR
First Name:ELIZA
Middle Name:MARGUERITE
Last Name:WHATLEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2290 KING AVE W
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-7415
Mailing Address - Country:US
Mailing Address - Phone:406-652-3192
Mailing Address - Fax:406-235-7089
Practice Address - Street 1:2290 KING AVE W
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-7415
Practice Address - Country:US
Practice Address - Phone:406-652-3192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-22
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12793207-9934152W00000X
MT4280152W00000X
WY447T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist