Provider Demographics
NPI:1598083941
Name:WHITE, SUE IRENE (CERTIFIED OPTICIAN)
Entity type:Individual
Prefix:MRS
First Name:SUE
Middle Name:IRENE
Last Name:WHITE
Suffix:
Gender:F
Credentials:CERTIFIED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2351 W MONROE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-1452
Mailing Address - Country:US
Mailing Address - Phone:217-787-8700
Mailing Address - Fax:217-787-8707
Practice Address - Street 1:2351 W MONROE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-1452
Practice Address - Country:US
Practice Address - Phone:217-787-8700
Practice Address - Fax:217-787-8707
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician