Organization
GENERATIONS FAMILY EYECARE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN A. WHITELEATHER OD (PRESIDENT/OWNER)
(260) 486-6106
Entity
Organization
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
05
—
200357500A
—
IN
01
—
CJ3814
RAILROAD MEDICARE GROUP
IN
Enumeration date
08/26/2005
Last updated
08/13/2008
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