Provider Demographics
NPI:1407882475
Name:WHITE, WILLIAM E (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:E
Last Name:WHITE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:H
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:5119 SUMMER AVE #101
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38122-4412
Mailing Address - Country:US
Mailing Address - Phone:901-761-2894
Mailing Address - Fax:901-761-2935
Practice Address - Street 1:5119 SUMMER AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38122-4412
Practice Address - Country:US
Practice Address - Phone:901-761-2894
Practice Address - Fax:901-761-2935
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN 787152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0062916OtherBLUE CROSS BLUE SHIELD
TN0062916Medicaid
TN7336Medicaid
TN4886OtherDAVIS VISION
TN7336Medicaid