MEDICARE: ANDREWS A. WHITE O.D.

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	939	CO

General Provider Information

NPI Number	:	1699703421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREWS A. WHITE O.D.

Provider Business Mailing Address
First Line	:	PO BOX 520
Second Line	:
City	:	CARBONDALE
State	:	CO
Zip	:	81623-0520
Country	:	US
Telephone Number	:	970-963-4187
Fax Number	:	970-963-4197

Provider Business Practice Location Address
First Line	:	1150 HWY 133
Second Line	:
City	:	CARBONDALE
State	:	CO
Zip	:	81623
Country	:	US
Telephone Number	:	970-963-4187
Fax Number	:	970-963-4197

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

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	07/13/2007

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