MEDICARE: WILLIAM FRANCIS WATERBURY II O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4901003906	MI
2	152WL0500X	Low Vision Rehabilitation Optometrist	4901003906	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043274327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM FRANCIS WATERBURY II O.D.

Provider Business Mailing Address
First Line	:	228 N. HELMER RD
Second Line	:
City	:	SPRINGFIELD
State	:	MI
Zip	:	49037-7931
Country	:	US
Telephone Number	:	269-963-5640
Fax Number	:	269-963-1666

Provider Business Practice Location Address
First Line	:	228 N. HELMER RD.
Second Line	:
City	:	SPRINGFIELD
State	:	MI
Zip	:	49037-7931
Country	:	US
Telephone Number	:	269-963-5640
Fax Number	:	269-963-1666

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	03/20/2017

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