Provider Demographics
NPI:1265604417
Name:WHITE, JAMES J (CERTIFIED OPTICIAN)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:WHITE
Suffix:
Gender:M
Credentials:CERTIFIED OPTICIAN
Other - Prefix:
Other - First Name:W E
Other - Middle Name:
Other - Last Name:OPTICIANS OF KENOSHA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:708 55TH ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-3732
Mailing Address - Country:US
Mailing Address - Phone:262-656-0101
Mailing Address - Fax:
Practice Address - Street 1:708 55TH ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-3732
Practice Address - Country:US
Practice Address - Phone:262-656-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WINZ038156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI5241970001Medicare NSC