Basic Information
| Provider Information | |||||||||
| NPI: | 1982686341 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITING | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 NEPONSET ST FL STREET12 | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016062714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9783457398 | ||||||||
| FaxNumber: | 9783530035 | ||||||||
| Practice Location | |||||||||
| Address1: | 64 BOYDEN RD | ||||||||
| Address2: | |||||||||
| City: | HOLDEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015202570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088569599 | ||||||||
| FaxNumber: | 5088294988 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2005 | ||||||||
| LastUpdateDate: | 03/26/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 3146 | MA | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 4652997 | 01 | AETNA US HEALTHCARE | OTHER | 042472266 | 01 | PRIVATE HEALTHCARE SYSTEM | OTHER | 47244 | 01 | CHILDRENS MEDICAL SECURIT | OTHER | W16043 | 01 | BLUE CARE ELECT | OTHER | 35481159 | 01 | CIGNA HEALTHSOURCE | OTHER | 60890 | 01 | FALLON COMMUNITY HEALTH P | OTHER | 785969 | 01 | MVP HEALTH CARE | OTHER | 042472266 | 01 | THREE RIVERS | OTHER | 2213200 | 01 | FIRST HEALTH | OTHER | AA2170 | 01 | HARVARD PILGRIM HEALTHCAR | OTHER | 042472266 | 01 | TRICARE CHAMPUS | OTHER | 6037084002 | 01 | CIGNA PAL ID | OTHER | W16043 | 01 | BLUE SHIELD HMO BLUE | OTHER | 0334910 | 05 | MA | MEDICAID | B291197401 | 01 | CIGNA HEALTH PLAN | OTHER |