Healthcare Provider Details

I. General information

NPI: 1154570836
Provider Name (Legal Business Name): HEATHER WHITE BRANDY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER WHITE O.D.

II. Dates (important events)

Enumeration Date: 09/17/2008
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 RODI RD SUITE 100
PITTSBURGH PA
15235-4564
US

IV. Provider business mailing address

1720 EL CAMINO REAL STE 235
BURLINGAME CA
94010-3213
US

V. Phone/Fax

Practice location:
  • Phone: 412-256-2020
  • Fax: 412-247-4963
Mailing address:
  • Phone: 650-259-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG-002135
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: