Provider Demographics
NPI:1407906852
Name:WHITE, DAMON BRYON (OD)
Entity Type:Individual
Prefix:DR
First Name:DAMON
Middle Name:BRYON
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 1:1300 E 15TH ST STE 170
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5042
Mailing Address - Country:US
Mailing Address - Phone:405-216-0707
Mailing Address - Fax:405-216-0707
Practice Address - Street 1:1300 E 15TH ST STE 170
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5042
Practice Address - Country:US
Practice Address - Phone:405-216-0707
Practice Address - Fax:405-216-0707
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2264152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy