Provider Demographics
NPI:1144450693
Name:WHATLEY, MARCUS AARON (OD)
Entity type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:AARON
Last Name:WHATLEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1247 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-7603
Mailing Address - Country:US
Mailing Address - Phone:817-481-2070
Mailing Address - Fax:817-410-9277
Practice Address - Street 1:1247 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-7603
Practice Address - Country:US
Practice Address - Phone:817-481-2070
Practice Address - Fax:817-410-9277
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2010-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7464TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist