Provider Demographics
NPI:1003811126
Name:WHEATALL, ROBERT CRAIG (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CRAIG
Last Name:WHEATALL
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 1:391 EVANS CITY RD
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-6737
Mailing Address - Country:US
Mailing Address - Phone:724-283-8144
Mailing Address - Fax:724-283-7303
Practice Address - Street 1:391 EVANS CITY RD
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-6737
Practice Address - Country:US
Practice Address - Phone:724-283-7303
Practice Address - Fax:724-283-8144
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000386152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA425817OtherHIGHMARK
PA0008778600004Medicaid
PA0146830001OtherMEDICARE DME
410024918OtherRAILROAD MEDICARE
PAT30354Medicare UPIN
PA425817OtherHIGHMARK