Provider Demographics
NPI:1972512168
Name:WHITLATCH, THOMAS EUGENE (O D)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EUGENE
Last Name:WHITLATCH
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2262 OLD PHILADELPHIA PIKE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-3417
Mailing Address - Country:US
Mailing Address - Phone:717-394-0108
Mailing Address - Fax:717-394-4729
Practice Address - Street 1:2262 OLD PHILADELPHIA PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-3417
Practice Address - Country:US
Practice Address - Phone:717-394-0108
Practice Address - Fax:717-394-4729
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000034152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT29546Medicare UPIN
PAWH143268Medicare ID - Type Unspecified