Provider Demographics
NPI:1932128220
Name:DR. ROY W. WHITEHOUSE, P.C.
Entity Type:Organization
Organization Name:DR. ROY W. WHITEHOUSE, P.C.
Other - Org Name:DRS. DAREN & WHITEHOUSE, P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:W
Authorized Official - Last Name:WHITEHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:434-292-3696
Mailing Address - Street 1:PO BOX 396
Mailing Address - Street 2:
Mailing Address - City:BLACKSTONE
Mailing Address - State:VA
Mailing Address - Zip Code:23824-0396
Mailing Address - Country:US
Mailing Address - Phone:434-292-3696
Mailing Address - Fax:
Practice Address - Street 1:401 CHURCH ST
Practice Address - Street 2:
Practice Address - City:BLACKSTONE
Practice Address - State:VA
Practice Address - Zip Code:23824-1603
Practice Address - Country:US
Practice Address - Phone:434-292-3696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001033152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA039810OtherANTHEM BCBS
VAU26738Medicare UPIN
VA039810OtherANTHEM BCBS
VAC03170Medicare PIN