Provider Demographics
NPI:1770668998
Name:WHITELOCK, JAMES JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JOSEPH
Last Name:WHITELOCK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19336 LEITERSBURG PIKE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742
Mailing Address - Country:US
Mailing Address - Phone:717-263-2389
Mailing Address - Fax:717-263-0884
Practice Address - Street 1:1013 WAYNE AVE
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201
Practice Address - Country:US
Practice Address - Phone:717-263-2389
Practice Address - Fax:717-263-0884
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0601002262152W00000X
MDTA0903152W00000X
PAOE006044T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAWH420385OtherHIGHMARK BLUE SHIELD
PA0008924180001Medicaid
410046909OtherRAILROAD MEDICARE
PA420385P3EMedicare ID - Type Unspecified
PAWH420385OtherHIGHMARK BLUE SHIELD