Individual provider Active NPI

Christopher Cockrum White, O.D.

  • Optometrist
  • Flowood, MS
National Provider Identifier
1073516456
Registry record updated Sep 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
759 Issued in MS
Practice address
5341 Lakeland Dr
Flowood, MS 39232-6173
Phone
(601) 919-1300
Fax
(601) 919-1133
NPI assigned
May 31, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 15, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 759 MS Primary

Addresses

Primary practice location

5341 Lakeland Dr
Flowood, MS 39232-6173

Mailing address

PO Box 5065
Brandon, MS 39047
Phone (601) 919-1300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140905001533 MS Practitioner - Optometry 9335119742 Practice locations: Flowood, MS

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

5341 Hwy 25
Flowood, MS 39232-6173
Phone (601) 919-1300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Poulin & Associates Eye Center Optometrist PastSince Apr 30, 2003 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1117497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694736000000",
    "number": "1073516456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5065",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "39047",
            "telephone_number": "601-919-1300",
            "fax_number": "601-919-1133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5341 LAKELAND DR",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392326173",
            "telephone_number": "601-919-1300",
            "fax_number": "601-919-1133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITE",
        "first_name": "CHRISTOPHER",
        "middle_name": "COCKRUM",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-05-31",
        "last_updated": "2023-09-15",
        "certification_date": "2023-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MS",
            "license": "759",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flowood, MS

Sources for this page

Verify at the official NPI Registry.