Organization
TW WHITE OD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THEODORE WM WHITE SR. O.D.,PC (OPTOMETRIST)
(417) 466-2100
Entity
Organization
Contact information
Practice address
410 W HAYWARD DR, MOUNT VERNON, MO 65712-7368
(417) 466-2100
(417) 466-0432
Mailing address
410 W HAYWARD DR, PO BOX 311, MOUNT VERNON, MO 65712-7368
(417) 466-2100
(417) 466-0432
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
002104
MO
Other
Enumeration date
02/19/2008
Last updated
03/06/2008
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