MEDICARE: MARK S 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	4901002542	MI

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

General Provider Information

NPI Number	:	1962491902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK S WHITE OD

Provider Business Mailing Address
First Line	:	1002 N US 27
Second Line	:
City	:	SAINT JOHNS
State	:	MI
Zip	:	48879-1129
Country	:	US
Telephone Number	:	989-224-3937
Fax Number	:	989-224-4999

Provider Business Practice Location Address
First Line	:	1002 N US 27
Second Line	:
City	:	SAINT JOHNS
State	:	MI
Zip	:	48879-1129
Country	:	US
Telephone Number	:	989-224-3937
Fax Number	:	989-224-4999

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

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	08/11/2011

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Directions to “ MARK S WHITE OD” Practice Location

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