Otis Victor Weatherholt, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

0618000350 Issued in VA

Practice address

1912 Graves Mill Rd
Lynchburg, VA 24502-4237

Phone

(434) 385-7898

Fax

(434) 385-1421

NPI assigned

Jul 22, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kraderod LLC

  • Optometrist
  • Lynchburg, VA
  • NPI 1730789603
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319760000000",
    "number": "1720009723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1912 GRAVES MILL RD",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245024237",
            "telephone_number": "434-385-7898",
            "fax_number": "434-385-1421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1912 GRAVES MILL RD",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245024237",
            "telephone_number": "434-385-7898",
            "fax_number": "434-385-1421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEATHERHOLT",
        "first_name": "OTIS",
        "middle_name": "VICTOR",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-22",
        "last_updated": "2011-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618000350",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009200703",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shelby Watson, BS
• Jessica L Watts, M.S., C.G.C.
• Samantha Waugerman
• Wear Well Counseling, LLC
• Carrie Weatherford
• Jacob Weatherholtz, LPC, CAADC
• Rose Mary Weaver
• Christopher Webb, MD
• Douglas Leon Webb, RPH
• Lauren Schiff Weber, DDS

• Optometrist in Lynchburg, VA
• Providers in Lynchburg, VA by specialty
• Optometrist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.