Individual
DR. ROY WILSON WHITEHOUSE III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
401 CHURCH ST, BLACKSTONE, VA 23824-1603
(434) 292-3696
Mailing address
PO BOX 396, BLACKSTONE, VA 23824-0396
(434) 292-3696
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618001033
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
039810
ANTHEM BCBS
VA
Enumeration date
11/12/2007
Last updated
11/12/2007
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