Provider Demographics
NPI:1285891309
Name:WHITE, RICHARD EDD (DO)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:EDD
Last Name:WHITE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8745 GLACIER HWY STE 426
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-8092
Mailing Address - Country:US
Mailing Address - Phone:907-796-3937
Mailing Address - Fax:907-796-3940
Practice Address - Street 1:8745 GLACIER HWY STE 426
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8092
Practice Address - Country:US
Practice Address - Phone:907-796-3937
Practice Address - Fax:907-796-3940
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK216156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKOP7385Medicaid