Healthcare Provider Details

I. General information

NPI: 1073516456
Provider Name (Legal Business Name): CHRISTOPHER COCKRUM WHITE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5341 LAKELAND DR
FLOWOOD MS
39232-6173
US

IV. Provider business mailing address

PO BOX 5065
BRANDON MS
39047
US

V. Phone/Fax

Practice location:
  • Phone: 601-919-1300
  • Fax: 601-919-1133
Mailing address:
  • Phone: 601-919-1300
  • Fax: 601-919-1133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number759
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: