Provider Demographics
NPI:1669506929
Name:J. M. WHITE, OD & ASSOCIATES, PA
Entity Type:Organization
Organization Name:J. M. WHITE, OD & ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MIKE
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:817-594-9191
Mailing Address - Street 1:4088 E. IH 20 SERVICE RD.
Mailing Address - Street 2:
Mailing Address - City:WILLOW PARK
Mailing Address - State:TX
Mailing Address - Zip Code:76087
Mailing Address - Country:US
Mailing Address - Phone:817-594-9191
Mailing Address - Fax:817-594-9190
Practice Address - Street 1:4088 E. IH 20 SERVICE RD.
Practice Address - Street 2:
Practice Address - City:WILLOW PARK
Practice Address - State:TX
Practice Address - Zip Code:76087
Practice Address - Country:US
Practice Address - Phone:817-594-9191
Practice Address - Fax:817-594-9190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2770TG152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0098FCOtherBCBS GROUP
TX7462322OtherAETNA
TXDA5868OtherPALMETTO GRP
TXP0064159OtherPALMETTO RAILROAD
TX80896QOtherBCBS
TX4974600001Medicare NSC
TXT44071Medicare UPIN
TX80896QOtherBCBS