Provider Demographics
NPI:1558357954
Name:WHITE, BRENDEN R (OD)
Entity Type:Individual
Prefix:DR
First Name:BRENDEN
Middle Name:R
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 1:10835 S 700 E
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-4702
Mailing Address - Country:US
Mailing Address - Phone:801-495-2020
Mailing Address - Fax:801-984-5665
Practice Address - Street 1:10835 S 700 E
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-4702
Practice Address - Country:US
Practice Address - Phone:801-495-2020
Practice Address - Fax:801-984-5665
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT274761-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT4339460001Medicare NSC
UTU58686Medicare UPIN
UT005708101Medicare PIN