Individual
WALTER O WHITLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
241 CORPORATE BLVD, NORFOLK, VA 23502-4965
(757) 622-2200
(757) 622-4866
Mailing address
241 CORPORATE BLVD, NORFOLK, VA 23502-4965
(757) 622-2200
(757) 622-4866
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618001719
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017589V49
MEDICARE
VA
05
—
1013976711
—
VA
Enumeration date
03/21/2006
Last updated
03/05/2013
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