Provider Demographics
NPI:1861552390
Name:WHITE, TERRY LYNN (OD)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:LYNN
Last Name:WHITE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:TERRI
Other - Middle Name:WHITE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1220 N TOWN EAST BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-7605
Mailing Address - Country:US
Mailing Address - Phone:972-613-9000
Mailing Address - Fax:972-613-0175
Practice Address - Street 1:1220 N TOWN EAST BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-7605
Practice Address - Country:US
Practice Address - Phone:972-613-9000
Practice Address - Fax:972-613-0175
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3705T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU14096Medicare UPIN