Provider Demographics
NPI:1861571234
Name:WHITNEY, BRIAN R (OD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:R
Last Name:WHITNEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 988
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720
Mailing Address - Country:US
Mailing Address - Phone:435-586-9949
Mailing Address - Fax:435-865-0388
Practice Address - Street 1:66 W HARDING AVE
Practice Address - Street 2:SUITE B
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720
Practice Address - Country:US
Practice Address - Phone:435-586-9949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1134229934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP00314487OtherMEDICARE RAILROAD
T82758Medicare UPIN
000058162Medicare ID - Type Unspecified