Provider Demographics
NPI:1639198807
Name:WHITWORTH OPTOMETRY, P.C.
Entity type:Organization
Organization Name:WHITWORTH OPTOMETRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:GLADE
Authorized Official - Last Name:WHITWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:816-795-7777
Mailing Address - Street 1:19045 E VALLEY VIEW PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-7030
Mailing Address - Country:US
Mailing Address - Phone:816-795-7777
Mailing Address - Fax:816-795-1290
Practice Address - Street 1:19045 E VALLEY VIEW PKWY STE A
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-7030
Practice Address - Country:US
Practice Address - Phone:816-795-7777
Practice Address - Fax:816-795-1290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO3371152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU68919Medicare UPIN
MOP127998Medicare ID - Type Unspecified
MOP128155Medicare ID - Type Unspecified
MOU68065Medicare UPIN