Provider Demographics
NPI:1124060462
Name:WITCHEY, RALPH G JR (OD)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:G
Last Name:WITCHEY
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 FARM COLONY DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-5203
Mailing Address - Country:US
Mailing Address - Phone:716-484-6700
Mailing Address - Fax:716-487-0166
Practice Address - Street 1:2 FARM COLONY DR
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-5203
Practice Address - Country:US
Practice Address - Phone:716-484-6700
Practice Address - Fax:716-487-0166
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE-G000882152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
151190OtherGATEWAY
65836OtherHEALTHAMERICA
0604250001OtherDMERC
WI116623OtherBLUE CROSS BLUE SHIELD
50320OtherDAVIS VISION
9-5-991-POtherVBA
25126OtherHEALTH AMERICA
PA0008713100001Medicaid
304695OtherUPMC
P00207495OtherR.R. MEDICARE
0604250001OtherDMERC
151190OtherGATEWAY