Provider Demographics
NPI:1225112568
Name:WHITE, KATHERINE (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 LINGLESTOWN RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-9499
Mailing Address - Country:US
Mailing Address - Phone:717-657-5030
Mailing Address - Fax:
Practice Address - Street 1:2151 LINGLESTOWN RD
Practice Address - Street 2:SUITE 210
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-9499
Practice Address - Country:US
Practice Address - Phone:717-657-5030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000765152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396530OtherNVA
PADA784868OtherCLARITY VISION
PA0784927OtherKEYSTONE HEALTH PLAN
PA396530OtherNVA