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General NPI Number Information
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NPI Number | 1174212252
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Entity Type | Organization
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Legal Business Name | A.M.C WHITE LLC
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Dates
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Enumeration Date | 05/03/2023
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Last Update Date | 05/03/2023
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Provider Practice Location Address
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Address Line | 100 MAIN ST N
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City | SOUTHBURY
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State | CT
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Zip | 06488-3840
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Country | US
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Telephone | 203-264-3937
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Fax |
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Provider Business Mailing Address
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Address Line | 435 MATTHEW ST
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City | PROSPECT
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State | CT
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Zip | 06712-1419
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Country | US
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Telephone | 917-341-3845
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Fax | 718-405-7599
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AUSTIN MATTHEW WHITE
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Credential | OD MHA
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Telephone | 917-341-3845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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