Basic Information
| Provider Information | |||||||||
| NPI: | 1124060462 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WITCHEY | ||||||||
| FirstName: | RALPH | ||||||||
| MiddleName: | G. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 FARM COLONY DR | ||||||||
| Address2: | |||||||||
| City: | WARREN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 163655203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7164846700 | ||||||||
| FaxNumber: | 7164870166 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 FARM COLONY DR | ||||||||
| Address2: | |||||||||
| City: | WARREN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 163655203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7164846700 | ||||||||
| FaxNumber: | 7164870166 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 04/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OE-G000882 | PA | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 151190 | 01 | GATEWAY | OTHER | 65836 | 01 | HEALTHAMERICA | OTHER | 0604250001 | 01 | DMERC | OTHER | WI116623 | 01 | BLUE CROSS BLUE SHIELD | OTHER | 50320 | 01 | DAVIS VISION | OTHER | 9-5-991-P | 01 | VBA | OTHER | 25126 | 01 | HEALTH AMERICA | OTHER | 0008713100001 | 05 | PA | MEDICAID | 304695 | 01 | UPMC | OTHER | P00207495 | 01 | R.R. MEDICARE | OTHER |