Provider Demographics
NPI:1598976441
Name:TREVOR WHITE, O.D., P.C.
Entity Type:Organization
Organization Name:TREVOR WHITE, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:SCHAEFFER
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-262-6611
Mailing Address - Street 1:100 N CHOCTAW AVE
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-2678
Mailing Address - Country:US
Mailing Address - Phone:405-262-6611
Mailing Address - Fax:
Practice Address - Street 1:100 N CHOCTAW AVE
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-2678
Practice Address - Country:US
Practice Address - Phone:405-262-6611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2438152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200195940AMedicaid
OK5295110001Medicare NSC
OKV00297Medicare UPIN
OK238421001Medicare ID - Type Unspecified