Healthcare Provider Details

I. General information

NPI: 1760642391
Provider Name (Legal Business Name): DR. GARY A. WHITE, OPTOMETRIST, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19272 STONE OAK PKWY STE. 106
SAN ANTONIO TX
78258-3371
US

IV. Provider business mailing address

19272 STONE OAK PKWY STE. 106
SAN ANTONIO TX
78258-3371
US

V. Phone/Fax

Practice location:
  • Phone: 210-481-7100
  • Fax: 210-481-7101
Mailing address:
  • Phone: 210-481-7100
  • Fax: 210-481-7101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberTX4599TG
License Number StateTX

VIII. Authorized Official

Name: DR. GARY A. WHITE
Title or Position: PRESIDENT/OWNER
Credential: O.D.
Phone: 210-481-7100