Provider Demographics
NPI:1760633424
Name:WHITAKER, NICOLE SUSAN (OD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:SUSAN
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 MAYSVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-7561
Mailing Address - Country:US
Mailing Address - Phone:740-450-2733
Mailing Address - Fax:
Practice Address - Street 1:2540 MAYSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-7561
Practice Address - Country:US
Practice Address - Phone:740-450-2733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5826152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist