Provider Demographics
NPI:1861495715
Name:WHITEHOUSE, CARL EDWARD (OD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:EDWARD
Last Name:WHITEHOUSE
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 1:50 BANK ST
Mailing Address - Street 2:
Mailing Address - City:ST ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-1636
Mailing Address - Country:US
Mailing Address - Phone:802-524-9561
Mailing Address - Fax:802-524-6060
Practice Address - Street 1:50 BANK ST
Practice Address - Street 2:
Practice Address - City:ST ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-1636
Practice Address - Country:US
Practice Address - Phone:802-524-9561
Practice Address - Fax:802-524-6060
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT140152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT7932OtherBLUE CROSS/BLUE SHIELD VT
VTP00179926OtherRAILROAD MEDICARE
VT7932Medicaid
VT59V018OtherMVP HEALTH CARE
VT59V018OtherMVP HEALTH CARE
VT7932OtherBLUE CROSS/BLUE SHIELD VT