Provider Demographics
NPI:1407925845
Name:WHITE, STEPHANIE MARY (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:MARY
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 1:212 RUE LANDRY
Mailing Address - Street 2:
Mailing Address - City:SAINT ROSE
Mailing Address - State:LA
Mailing Address - Zip Code:70087-3666
Mailing Address - Country:US
Mailing Address - Phone:504-710-1129
Mailing Address - Fax:
Practice Address - Street 1:5110 JEFFERSON HWY
Practice Address - Street 2:VISION CENTER
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123-5302
Practice Address - Country:US
Practice Address - Phone:504-818-1463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2021-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1269-423T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2497782Medicaid