Provider Demographics
NPI:1629130810
Name:DRS WHITTINGTON & WHITTINGTON PTR
Entity Type:Organization
Organization Name:DRS WHITTINGTON & WHITTINGTON PTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WHITTINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-342-0660
Mailing Address - Street 1:3840 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-4650
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:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-4650
Practice Address - Country:US
Practice Address - Phone:304-342-0660
Practice Address - Fax:304-344-5483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0316310001Medicare NSC
WV9197833Medicare PIN
WVDG3793Medicare PIN