Provider Demographics
NPI:1528012333
Name:WHITE, AUSTIN MATTHEW CIAZ (OD)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:MATTHEW CIAZ
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 1:435 MATTHEW ST
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:CT
Mailing Address - Zip Code:06712-1419
Mailing Address - Country:US
Mailing Address - Phone:917-341-3845
Mailing Address - Fax:718-822-2838
Practice Address - Street 1:4336B WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-3094
Practice Address - Country:US
Practice Address - Phone:718-405-7211
Practice Address - Fax:718-405-7599
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005575152W00000X
NYVUT5575152WC0802X
CT002905152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01503153Medicaid
NYC4A531Medicare ID - Type Unspecified
NY01503153Medicaid