Provider Demographics
NPI:1417964891
Name:WHITTINGTON, SANDRA H (OD)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:H
Last Name:WHITTINGTON
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 1:3840 PENNSYLVANIA AVE
Mailing Address - Street 2:WHITTINGTON & WHITTINGTON
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302
Mailing Address - Country:US
Mailing Address - Phone:304-342-0660
Mailing Address - Fax:304-344-5483
Practice Address - Street 1:3840 PENNSYLVANIA AVE
Practice Address - Street 2:WHITTINGTON & WHITTINGTON
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302
Practice Address - Country:US
Practice Address - Phone:304-342-0660
Practice Address - Fax:304-344-5483
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV775OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0149259000Medicaid
T32392Medicare UPIN
WV0149259000Medicaid
WVWH0573482Medicare ID - Type Unspecified