Provider Demographics
NPI:1710020482
Name:WHITE, CHRISTOPHER THOMAS (OD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:THOMAS
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:PO BOX 181
Mailing Address - Street 2:
Mailing Address - City:EASTSOUND
Mailing Address - State:WA
Mailing Address - Zip Code:98245-0181
Mailing Address - Country:US
Mailing Address - Phone:360-376-5310
Mailing Address - Fax:866-393-7127
Practice Address - Street 1:1286 MOUNT BAKER RD
Practice Address - Street 2:SUITE B
Practice Address - City:EASTSOUND
Practice Address - State:WA
Practice Address - Zip Code:98245-8931
Practice Address - Country:US
Practice Address - Phone:360-376-5310
Practice Address - Fax:866-393-7127
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001839152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8873411OtherMEMBER'S PROVIDER TRANSACTION ACESS NUMBER PTAN
WA2029650Medicaid
WAU03038Medicare UPIN