Healthcare Provider Details

I. General information

NPI: 1699987768
Provider Name (Legal Business Name): ERIC M. WHITE OD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5075 RUFFIN RD STE B
SAN DIEGO CA
92123-1698
US

IV. Provider business mailing address

5075 RUFFIN RD STE B
SAN DIEGO CA
92123-1698
US

V. Phone/Fax

Practice location:
  • Phone: 858-278-4720
  • Fax: 858-278-3640
Mailing address:
  • Phone: 858-278-4720
  • Fax: 858-278-3640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number8611T
License Number StateCA

VIII. Authorized Official

Name: DR. ERIC MILTON WHITE
Title or Position: OWNER
Credential: OD
Phone: 858-278-4720