Doctor Name: | JOHN MIKE WHITE |
NPI Number: | 1457388597 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | O.D. |
License Number: | 2770TG |
Business Practice Address: | 4088 E Interstate 20 Service Rd S Willow Park, TX - 760873647 |
Business Phone Number: | 8175949191 |
Business Fax Number: | 8175949190 |
Mailing Address: | 4088 E. Ih 20 Service Rd., WILLOW PARK |
State: | TX |
Postal Code: | 76087 |
Phone Number: | 8175960646 |
Fax Number: | 8175949190 |
NPI Enumeration Date: | 06/26/2006 |
NPI Last Update Date: | 02/04/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 152WC0802X |
License Number: | 2770TG |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Optometrist |
Taxonomy Specialization: | Corneal and Contact Management |
Taxonomy Definition: | The professional activities performed by an Optometrist related to the fitting of contact lenses to an eye, ongoing evaluation of the cornea |