Provider Demographics
NPI:1134205818
Name:WHITE, RENEE T (OD, MS)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:T
Last Name:WHITE
Suffix:
Gender:F
Credentials:OD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5535 MOREHOUSE DR. BLDG. S
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-6808
Mailing Address - Country:US
Mailing Address - Phone:858-651-5918
Mailing Address - Fax:
Practice Address - Street 1:10155 PACCIFIC HEIGHTS BLVD BLDG. AZ
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-5307
Practice Address - Country:US
Practice Address - Phone:858-248-8622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10563T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOP10563Medicare PIN