Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OEG000386 | PA |
NPI | 1003811126 |
---|---|
Provider Name | Dr. Robert Craig Wheatall |
First Address | Butler, PA 16001-1970 |
Second Address | Butler, PA 16001-1970 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2005 |
Last Update Date | 30/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0008778600004 | (05) | PA |
0146830001 | MEDICARE DME (01) | PA |
410024918 | RAILROAD MEDICARE (01) | |
425817 | HIGHMARK (01) | PA |
T30354 | (02) | PA |