Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 282T | WY |
NPI | 1013034032 |
---|---|
Provider Name | Dr. Jason B Whitman |
First Address | Casper, WY 82605-1044 |
Second Address | Casper, WY 82609-4215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2007 |
Last Update Date | 17/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U93934 | (02) | WY |