Provider Demographics
NPI:1760667562
Name:NELSON R. WHITLING, OD CO
Entity Type:Organization
Organization Name:NELSON R. WHITLING, OD CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:R
Authorized Official - Last Name:WHITLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-226-4862
Mailing Address - Street 1:1350 E MAIN ST
Mailing Address - Street 2:STE 20
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-6278
Mailing Address - Country:US
Mailing Address - Phone:814-226-4862
Mailing Address - Fax:814-226-8741
Practice Address - Street 1:1350 E MAIN ST
Practice Address - Street 2:STE 20
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-6278
Practice Address - Country:US
Practice Address - Phone:814-226-4862
Practice Address - Fax:814-226-8741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000514152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0756100001Medicare NSC