Healthcare Provider Details

I. General information

NPI: 1962552992
Provider Name (Legal Business Name): BYRON LEE WHITE C.O.F
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2034 DABNEY RD SUITE C
RICHMOND VA
23230-3361
US

IV. Provider business mailing address

2312 GORDON ST
HOPEWELL VA
23860-3421
US

V. Phone/Fax

Practice location:
  • Phone: 804-649-9043
  • Fax: 804-783-8212
Mailing address:
  • Phone: 804-458-6935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: