Provider Demographics
NPI:1720064231
Name:WHITAKER, LINDA A (OD, MS)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:A
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:OD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GRANITE POINT DR STE 100
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1992
Mailing Address - Country:US
Mailing Address - Phone:610-378-1344
Mailing Address - Fax:610-378-9508
Practice Address - Street 1:219 E WESNER RD
Practice Address - Street 2:
Practice Address - City:BLANDON
Practice Address - State:PA
Practice Address - Zip Code:19510-9729
Practice Address - Country:US
Practice Address - Phone:610-926-4241
Practice Address - Fax:610-926-8160
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000926152WL0500X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001433106003Medicaid
PAU43060Medicare UPIN
PA056820H4XMedicare ID - Type Unspecified