Provider Demographics
NPI:1720235955
Name:WHITT, TRAVIS K (OD)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:K
Last Name:WHITT
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 1:1925 N 22ND AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-7020
Mailing Address - Country:US
Mailing Address - Phone:406-219-0700
Mailing Address - Fax:605-371-7199
Practice Address - Street 1:1925 N 22ND AVE STE 201
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-7020
Practice Address - Country:US
Practice Address - Phone:406-219-0700
Practice Address - Fax:605-371-7199
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3959152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist