Provider Demographics
NPI:1740258987
Name:WHITESCARVER, KATHRYN (OD)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:
Last Name:WHITESCARVER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:1404 FORREST AVE STE 1
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3478
Practice Address - Country:US
Practice Address - Phone:302-346-2020
Practice Address - Fax:302-724-6549
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000370152W00000X
DCOP748152W00000X
DEI3-0011430152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9237062Medicaid
VAU83303Medicare UPIN
VA491708Medicare PIN