Provider Demographics
NPI:1053614214
Name:GEOFFREY G WHITE MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:GEOFFREY G WHITE MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:G
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-373-7733
Mailing Address - Street 1:966 CASS ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4540
Mailing Address - Country:US
Mailing Address - Phone:831-373-7733
Mailing Address - Fax:831-373-3358
Practice Address - Street 1:966 CASS ST STE 100
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4540
Practice Address - Country:US
Practice Address - Phone:831-373-7733
Practice Address - Fax:831-373-3358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-09
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG15580207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA181912084OtherMEDICARE RAILROAD
CA0544300001OtherDMERC
CA00G155800Medicaid
CA00G155800Medicaid
CA00G15580Medicare PIN