Provider Demographics
NPI:1407836968
Name:WHITTREDGE, BENJAMIN LANE (OD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:LANE
Last Name:WHITTREDGE
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 1:3120 N PLUM ST
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-2918
Mailing Address - Country:US
Mailing Address - Phone:620-662-2355
Mailing Address - Fax:620-662-1102
Practice Address - Street 1:3120 N PLUM ST
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-2918
Practice Address - Country:US
Practice Address - Phone:620-662-2355
Practice Address - Fax:620-662-1102
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1882152W00000X
IN18003558A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist