Provider Demographics
NPI:1841218781
Name:ROBERT C. WHEATALL, OD
Entity Type:Organization
Organization Name:ROBERT C. WHEATALL, OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:WHEATALL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:724-287-1771
Mailing Address - Street 1:116 EVANS RD
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-1970
Mailing Address - Country:US
Mailing Address - Phone:724-287-1771
Mailing Address - Fax:724-287-6572
Practice Address - Street 1:116 EVANS RD
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-1970
Practice Address - Country:US
Practice Address - Phone:724-287-1771
Practice Address - Fax:724-287-6572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000386152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1009472500001Medicaid
CH8979OtherRAILROAD MEDICARE
PA001329946OtherHIGHMARK BLUE SHIELD
CH8979OtherRAILROAD MEDICARE
PA001329946OtherHIGHMARK BLUE SHIELD
PA1009472500001Medicaid
PAT30354Medicare UPIN