Provider Demographics
NPI:1568493005
Name:WHITSON VISION, PC
Entity Type:Organization
Organization Name:WHITSON VISION, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:WHITSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-844-5500
Mailing Address - Street 1:901 E 86TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1807
Mailing Address - Country:US
Mailing Address - Phone:317-844-5500
Mailing Address - Fax:317-573-4230
Practice Address - Street 1:1115 RONALD REAGAN PKWY
Practice Address - Street 2:SUITE 223
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-6910
Practice Address - Country:US
Practice Address - Phone:317-217-3937
Practice Address - Fax:317-217-3950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002221A152W00000X
IN01036301A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100072590DMedicaid
IN000000102683OtherBC/BS GROUP #
IN0234750004Medicare PIN
IN097950Medicare PIN
INC30398Medicare PIN
IN000000102683OtherBC/BS GROUP #