Provider Demographics
NPI:1265438956
Name:WHITLOW, ROBERT N II (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:N
Last Name:WHITLOW
Suffix:II
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 1:1406 W STOCKTON ST
Mailing Address - Street 2:
Mailing Address - City:EDMONTON
Mailing Address - State:KY
Mailing Address - Zip Code:42129-8125
Mailing Address - Country:US
Mailing Address - Phone:270-432-0123
Mailing Address - Fax:270-432-5899
Practice Address - Street 1:1406 W STOCKTON ST
Practice Address - Street 2:
Practice Address - City:EDMONTON
Practice Address - State:KY
Practice Address - Zip Code:42129-8125
Practice Address - Country:US
Practice Address - Phone:270-432-0123
Practice Address - Fax:270-432-5899
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1226DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77012268Medicaid
KY77012268Medicaid
KY0587702Medicare PIN