Provider Demographics
NPI:1841567591
Name:DESTIN D. WHIPPLE, OD, PLLC
Entity type:Organization
Organization Name:DESTIN D. WHIPPLE, OD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DESTIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WHIPPLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:480-545-8985
Mailing Address - Street 1:590 N ALMA SCHOOL RD STE 17
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4332
Mailing Address - Country:US
Mailing Address - Phone:480-821-2020
Mailing Address - Fax:480-545-9384
Practice Address - Street 1:590 N ALMA SCHOOL RD STE 17
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4332
Practice Address - Country:US
Practice Address - Phone:480-821-2020
Practice Address - Fax:480-821-7968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-23
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1813152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ149663Medicare PIN
AZDT2447Medicare PIN