Provider Demographics
NPI:1689644601
Name:WHITING, ABBY LEIGH (OD)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:LEIGH
Last Name:WHITING
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ABBY
Other - Middle Name:LEIGH
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2055 MERCER NEW WILMINGTON RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NEW WILMINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:16142-2027
Mailing Address - Country:US
Mailing Address - Phone:724-946-2620
Mailing Address - Fax:724-946-2622
Practice Address - Street 1:2055 MERCER NEW WILMINGTON RD
Practice Address - Street 2:SUITE 2
Practice Address - City:NEW WILMINGTON
Practice Address - State:PA
Practice Address - Zip Code:16142-2027
Practice Address - Country:US
Practice Address - Phone:724-946-2620
Practice Address - Fax:724-946-2622
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001658152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAV07262Medicare UPIN
PA095902URTMedicare ID - Type UnspecifiedGROUP MEMBER PROVIDER NBR
PA095885Medicare PIN