Provider Demographics
NPI:1760642391
Name:DR. GARY A. WHITE, OPTOMETRIST, P.C.
Entity Type:Organization
Organization Name:DR. GARY A. WHITE, OPTOMETRIST, P.C.
Other - Org Name:GMVC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:210-481-7100
Mailing Address - Street 1:19272 STONE OAK PKWY
Mailing Address - Street 2:STE. 106
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3371
Mailing Address - Country:US
Mailing Address - Phone:210-481-7100
Mailing Address - Fax:210-481-7101
Practice Address - Street 1:19272 STONE OAK PKWY
Practice Address - Street 2:STE. 106
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3371
Practice Address - Country:US
Practice Address - Phone:210-481-7100
Practice Address - Fax:210-481-7101
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. GARY A. WHITE, OPTOMETRIST, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX4599TG152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty