Provider Demographics
NPI:1104904416
Name:WHITLOCK, ROBERT HOWARD (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:HOWARD
Last Name:WHITLOCK
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 1:5017 WOODBOX LN
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-4856
Mailing Address - Country:US
Mailing Address - Phone:717-796-9371
Mailing Address - Fax:
Practice Address - Street 1:5030 JONESTOWN RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-2921
Practice Address - Country:US
Practice Address - Phone:717-657-0803
Practice Address - Fax:717-526-9808
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000262152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU60789Medicare UPIN