Provider Demographics
NPI:1124478151
Name:WHITE, KORY (OD)
Entity type:Individual
Prefix:
First Name:KORY
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3665 S 8400 W
Mailing Address - Street 2:STE 100
Mailing Address - City:MAGNA
Mailing Address - State:UT
Mailing Address - Zip Code:84044-4907
Mailing Address - Country:US
Mailing Address - Phone:801-250-5745
Mailing Address - Fax:801-250-5981
Practice Address - Street 1:3665 S 8400 W
Practice Address - Street 2:STE 100
Practice Address - City:MAGNA
Practice Address - State:UT
Practice Address - Zip Code:84044-4907
Practice Address - Country:US
Practice Address - Phone:801-250-5745
Practice Address - Fax:801-250-5981
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-100379152W00000X
UT9831093-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist