Basic Information
| Provider Information | |||||||||
| NPI: | 1598317117 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHIPPLE | ||||||||
| FirstName: | DEVIN | ||||||||
| MiddleName: | TALMAGE | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1356 S GILBERT RD | ||||||||
| Address2: | STE 3 | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852046077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805458985 | ||||||||
| FaxNumber: | 4805459384 | ||||||||
| Practice Location | |||||||||
| Address1: | 15465 W MCDOWELL RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | GOODYEAR | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853952528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6232472706 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2019 | ||||||||
| LastUpdateDate: | 01/06/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPT-002362 | AZ | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.