Individual
DR. KEVIN A. WHITELEATHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
4201 LAHMEYER RD, FORT WAYNE, IN 46815-5676
(260) 486-6106
Mailing address
4201 LAHMEYER RD, FORT WAYNE, IN 46815-5676
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18003140A
IN
152WC0802X
Corneal and Contact Management Optometrist
18003140A
IN
152WL0500X
Low Vision Rehabilitation Optometrist
18003140A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000225758
ANTHEM BC/BS PROVIDER NO.
IN
01
—
7470288
AETNA PROVIDER NUMBER
IN
Enumeration date
05/24/2005
Last updated
10/26/2007
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