Organization
TW WHITE OD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. T W WHITE O.D. (OPTOMETRIC DOCTOR)
(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
PO BOX 311, 410 W HAYWARD DR, MOUNT VERNON, MO 65712-0311
(417) 466-2100
(417) 466-0432
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2104
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
310151006
—
MO
Enumeration date
02/11/2010
Last updated
02/11/2010
Update your record
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