Provider Demographics
NPI:1427228675
Name:GEOFFREY A WHITE & ASSOC. INC.
Entity Type:Organization
Organization Name:GEOFFREY A WHITE & ASSOC. INC.
Other - Org Name:CENTRAL SQUARE EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:617-497-2015
Mailing Address - Street 1:3 CENTRAL SQ
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3310
Mailing Address - Country:US
Mailing Address - Phone:617-497-2015
Mailing Address - Fax:617-497-2025
Practice Address - Street 1:3 CENTRAL SQ
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3310
Practice Address - Country:US
Practice Address - Phone:617-497-2015
Practice Address - Fax:617-497-2025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3984152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0369799Medicaid
MA0369799Medicaid
MAW17453Medicare PIN