Provider Demographics
NPI:1689928921
Name:WHITE, AUSTIN GREGORY (OD)
Entity type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:GREGORY
Last Name:WHITE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:232 CRAFTON INGRAM SHP CTR
Practice Address - Street 2:
Practice Address - City:CRAFTON
Practice Address - State:PA
Practice Address - Zip Code:15205-2353
Practice Address - Country:US
Practice Address - Phone:412-922-2305
Practice Address - Fax:412-922-0688
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-08
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1098-IOD152W00000X, 152W00000X
PAOEG002895152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810025073Medicaid