Provider Demographics
NPI:1689928921
Name:WHITE, AUSTIN GREGORY (OD)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:GREGORY
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 1:206 WINGATE DRIVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15205
Mailing Address - Country:US
Mailing Address - Phone:304-723-4222
Mailing Address - Fax:304-723-4222
Practice Address - Street 1:400 THREE SPRINGS DRIVE
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062
Practice Address - Country:US
Practice Address - Phone:304-723-4222
Practice Address - Fax:304-723-4222
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1097-IOD1152W00000X
PAOEG002895152W00000X
WV1098-IOD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810025073Medicaid