Individual
DR. AUSTIN MATTHEW CIAZ WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
961 E 174TH ST, BRONX, NY 10460-5060
(347) 498-1478
(347) 284-5543
Mailing address
435 MATTHEW ST, PROSPECT, CT 06712-1419
(917) 341-3845
(718) 822-2838
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
002905
CT
152W00000X
Optometrist
005575
NY
152WC0802X
Corneal and Contact Management Optometrist
005575
NY
152WC0802X
Corneal and Contact Management Optometrist
VUT5575
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002905
CT LICENSE
CT
05
—
01503153
—
NY
Enumeration date
05/19/2006
Last updated
05/16/2025
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