MEDICARE: VINCENT W. WHITE OD, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier
2	152W00000X	Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457501231
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VINCENT W. WHITE OD, INC.

Provider Business Mailing Address
First Line	:	15230 BURBANK BLVD
Second Line	:	# 109
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91411-3534
Country	:	US
Telephone Number	:	818-779-0152
Fax Number	:	818-779-0854

Provider Business Practice Location Address
First Line	:	15230 BURBANK BLVD
Second Line	:	# 109
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91411-3534
Country	:	US
Telephone Number	:	818-779-0152
Fax Number	:	818-779-0854

Authorized Official
Title or Position	:	OWNER
Name	:	DR. VINCENT WILLIAM WHITE
Credential	:	OD
Telephone Number	:	818-779-0152

Provider Enumeration Date	:	09/29/2008
Last Update Date	:	09/29/2008

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Directions to “VINCENT W. WHITE OD, INC. ” Practice Location

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