Provider Demographics
NPI:1023188570
Name:WHITE, TREVOR SCHAEFFER (OD)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:SCHAEFFER
Last Name:WHITE
Suffix:
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 1:100 N CHOCTAW AVE
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-2678
Mailing Address - Country:US
Mailing Address - Phone:405-262-6611
Mailing Address - Fax:405-262-6618
Practice Address - Street 1:100 N CHOCTAW AVE
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-2678
Practice Address - Country:US
Practice Address - Phone:405-262-6611
Practice Address - Fax:405-262-6618
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2438152WV0400X, 152WX0102X, 152W00000X, 152WL0500X, 152WC0802X, 152WP0200X, 152WS0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00150242OtherRAILROAD MEDICARE
OK200037580 AMedicaid
OKV00297Medicare UPIN
OK200037580 AMedicaid