Individual
JOHN MIKE WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
4088 E INTERSTATE 20 SERVICE RD S, WILLOW PARK, TX 76087-3647
(817) 594-9191
(817) 594-9190
Mailing address
4088 E. IH 20 SERVICE RD., WILLOW PARK, TX 76087
(817) 596-0646
(817) 594-9190
Taxonomy
Speciality
Code
Description
License number
State
152WC0802X
Corneal and Contact Management Optometrist
Primary
2770TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0098FC
BCBS GROUP
TX
01
—
7462322
AETNA
TX
01
—
80896Q
BCBS
TX
01
—
DA5868
PALMETTO GRP
TX
01
—
P0064159
PALMETTO RAILROAD
TX
Enumeration date
06/26/2006
Last updated
02/04/2008
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