MEDICARE: DR. MEGAN ALEXANDRA WHITE OD

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	152W00000X	Optometrist	10026T	TX
2	390200000X	Student in an Organized Health Care Education/Training Program		TX

General Provider Information

NPI Number	:	1518576834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEGAN ALEXANDRA WHITE OD

Provider Business Mailing Address
First Line	:	1109 ROCK PRAIRIE RD STE 300
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-8651
Country	:	US
Telephone Number	:	979-764-0669
Fax Number	:	855-325-7670

Provider Business Practice Location Address
First Line	:	1109 ROCK PRAIRIE RD STE 300
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-8651
Country	:	US
Telephone Number	:	979-764-0669
Fax Number	:	855-325-7670

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2020
Last Update Date	:	10/07/2022

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