Basic Information
Provider Information
NPI: 1720128895
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WHITSETT
FirstName: AARON
MiddleName: JOHN
NamePrefix: DR.
NameSuffix:  
Credential: OD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1950 OLD GALLOWS RD STE 520
Address2:  
City: VIENNA
State: VA
PostalCode: 221823970
CountryCode: US
TelephoneNumber: 7038478899
FaxNumber: 5712236780
Practice Location
Address1: 3013 OAKLAND DR
Address2:  
City: KALAMAZOO
State: MI
PostalCode: 490085901
CountryCode: US
TelephoneNumber: 2693823453
FaxNumber: 2693822740
Other Information
ProviderEnumerationDate: 02/07/2007
LastUpdateDate: 04/08/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/08/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
152W00000X4901004329MIY Eye and Vision Services ProvidersOptometrist 

No ID Information.


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