MEDICARE: DR. STEPHEN SPINDLER 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	18001405	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3944090001	OTHER	IN	DMOPS #

General Provider Information

NPI Number	:	1902916075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN SPINDLER WHITE O.D.

Provider Business Mailing Address
First Line	:	430 E 280 N
Second Line	:
City	:	ANGOLA
State	:	IN
Zip	:	46703-9587
Country	:	US
Telephone Number	:	260-343-0149
Fax Number	:	260-343-0283

Provider Business Practice Location Address
First Line	:	2501 E NORTH ST
Second Line	:
City	:	KENDALLVILLE
State	:	IN
Zip	:	46755-3231
Country	:	US
Telephone Number	:	260-343-0149
Fax Number	:	260-343-0283

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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