Provider Demographics
NPI:1730117524
Name:WHITESEL, DARIN MARK (OD)
Entity Type:Individual
Prefix:DR
First Name:DARIN
Middle Name:MARK
Last Name:WHITESEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 181
Mailing Address - Street 2:6 PARKSIDE CT.
Mailing Address - City:MIFFLINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17059-0181
Mailing Address - Country:US
Mailing Address - Phone:717-436-8955
Mailing Address - Fax:717-436-2443
Practice Address - Street 1:6 PARKSIDE CT
Practice Address - Street 2:
Practice Address - City:MIFFLINTOWN
Practice Address - State:PA
Practice Address - Zip Code:17059-9012
Practice Address - Country:US
Practice Address - Phone:717-436-8955
Practice Address - Fax:717-436-2443
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000339152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist