Provider Demographics
NPI:1447440672
Name:WHITE, DEBORAH ELIZABETH (LICENSED OPTICAIN)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:ELIZABETH
Last Name:WHITE
Suffix:
Gender:F
Credentials:LICENSED OPTICAIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 S LOUDOUN ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3612
Mailing Address - Country:US
Mailing Address - Phone:540-665-0255
Mailing Address - Fax:540-665-0257
Practice Address - Street 1:2017 S LOUDOUN ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3612
Practice Address - Country:US
Practice Address - Phone:540-665-0255
Practice Address - Fax:540-665-0257
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA002510156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6739OtherDAVIS VISION
VA287005OtherANTHEM
VAVA 2510OtherEYEMED