Provider Demographics
NPI:1902916075
Name:WHITE, STEPHEN SPINDLER (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:SPINDLER
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 1:430 E 280 N
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46703-9587
Mailing Address - Country:US
Mailing Address - Phone:260-343-0149
Mailing Address - Fax:260-343-0283
Practice Address - Street 1:2501 E NORTH ST
Practice Address - Street 2:
Practice Address - City:KENDALLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46755-3231
Practice Address - Country:US
Practice Address - Phone:260-343-0149
Practice Address - Fax:260-343-0283
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001405152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN3944090001OtherDMOPS #
IN3944090001OtherDMOPS #
IN771700Medicare ID - Type UnspecifiedLOCATION #