Provider Demographics
NPI:1528138757
Name:WHALEN, CATHERINE J (OPTICIAN)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:J
Last Name:WHALEN
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5970 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2430
Mailing Address - Country:US
Mailing Address - Phone:815-395-1820
Mailing Address - Fax:815-395-9135
Practice Address - Street 1:5970 E STATE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2430
Practice Address - Country:US
Practice Address - Phone:815-395-1820
Practice Address - Fax:815-395-9135
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0148350001Medicare NSC