Provider Demographics
NPI:1073516456
Name:WHITE, CHRISTOPHER COCKRUM (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:COCKRUM
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:PO BOX 5065
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047
Mailing Address - Country:US
Mailing Address - Phone:601-919-1300
Mailing Address - Fax:601-919-1133
Practice Address - Street 1:5341 LAKELAND DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-6173
Practice Address - Country:US
Practice Address - Phone:601-919-1300
Practice Address - Fax:601-919-1133
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS759152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEU89194Medicare UPIN