Provider Demographics
NPI:1447394739
Name:WHITAKER, STEPHEN ANTHONY (OWNER)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:ANTHONY
Last Name:WHITAKER
Suffix:
Gender:M
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 E SWEDESFORD RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-1462
Mailing Address - Country:US
Mailing Address - Phone:610-688-2686
Mailing Address - Fax:
Practice Address - Street 1:271 E SWEDESFORD RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-1462
Practice Address - Country:US
Practice Address - Phone:610-688-2686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician