Provider Demographics
NPI:1265530075
Name:WHITE, THOMAS MARSHALL (OD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MARSHALL
Last Name:WHITE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8801 HORIZON BLVD NE
Mailing Address - Street 2:SUITE 360
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1533
Mailing Address - Country:US
Mailing Address - Phone:505-828-4923
Mailing Address - Fax:505-213-0103
Practice Address - Street 1:1606 SE MAIN ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203-5411
Practice Address - Country:US
Practice Address - Phone:575-624-0370
Practice Address - Fax:575-624-0376
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS1166-3152W00000X
NM290152W00000X
TX7908-T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM13938274Medicaid
NM367317YTQZMedicare PIN