Provider Demographics
NPI:1265466379
Name:WHITE, GEORGE EDWARD III (OD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:EDWARD
Last Name:WHITE
Suffix:III
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 1:426 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438
Mailing Address - Country:US
Mailing Address - Phone:215-256-6735
Mailing Address - Fax:215-256-9931
Practice Address - Street 1:426 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438
Practice Address - Country:US
Practice Address - Phone:215-256-6735
Practice Address - Fax:215-256-9931
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0EG001408152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0048822000OtherKEYSTONE HEALTH PLAN EAST
037493OtherBLUE SHIELD
T72390Medicare UPIN
440999Medicare ID - Type Unspecified