Healthcare Provider Details

I. General information

NPI: 1457501231
Provider Name (Legal Business Name): VINCENT W. WHITE OD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2008
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15230 BURBANK BLVD # 109
SHERMAN OAKS CA
91411-3534
US

IV. Provider business mailing address

15230 BURBANK BLVD # 109
SHERMAN OAKS CA
91411-3534
US

V. Phone/Fax

Practice location:
  • Phone: 818-779-0152
  • Fax: 818-779-0854
Mailing address:
  • Phone: 818-779-0152
  • Fax: 818-779-0854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. VINCENT WILLIAM WHITE
Title or Position: OWNER
Credential: OD
Phone: 818-779-0152