Provider Demographics
NPI:1538237771
Name:WHATLEY EYE CARE, P.C.
Entity type:Organization
Organization Name:WHATLEY EYE CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WHATLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:334-745-3112
Mailing Address - Street 1:518 AVENUE A
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-5064
Mailing Address - Country:US
Mailing Address - Phone:334-745-3112
Mailing Address - Fax:334-745-8751
Practice Address - Street 1:518 AVENUE A
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5064
Practice Address - Country:US
Practice Address - Phone:334-745-3112
Practice Address - Fax:334-745-8751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-720-TA-192152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51531835OtherBLUE CROSS
AL529926430Medicaid
ALOT42627OtherUNITED HEALTH CARE
ALT-98178Medicare UPIN
AL529926430Medicaid