Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | ODOOOOO672 | WA |
NPI | 1003976358 |
---|---|
Provider Name | Dr. Kenneth L White |
First Address | Gig Harbor, WA 98332-7545 |
Second Address | Gig Harbor, WA 98332-7545 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2006 |
Last Update Date | 29/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T02917 | (02) |