Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 002398 | IA |
NPI | 1003096629 |
---|---|
Provider Name | Samuel P Whitmore |
First Address | Des Moines, IA 50312-3410 |
Second Address | Urbandale, IA 50322-4008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2007 |
Last Update Date | 16/09/2013 |