Provider Demographics
NPI:1235813643
Name:WHITE, RICHARD CHRISTIAN (OD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:CHRISTIAN
Last Name:WHITE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 COSTA DEL ORO ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-2619
Mailing Address - Country:US
Mailing Address - Phone:801-822-3372
Mailing Address - Fax:
Practice Address - Street 1:107 JAMES COLEMAN DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-3100
Practice Address - Country:US
Practice Address - Phone:361-578-0234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10822TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist