MEDICARE: WILLIAM A. COLE 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	OPC3103	FL

General Provider Information

NPI Number	:	1093867236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM A. COLE O.D.

Provider Business Mailing Address
First Line	:	PO BOX 226
Second Line	:
City	:	HIGH SPRINGS
State	:	FL
Zip	:	32655-0226
Country	:	US
Telephone Number	:	386-454-1687
Fax Number	:

Provider Business Practice Location Address
First Line	:	2133 W US HIGHWAY 90
Second Line	:	SUITE 170
City	:	LAKE CITY
State	:	FL
Zip	:	32055-4705
Country	:	US
Telephone Number	:	386-755-2400
Fax Number	:	386-755-2400

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

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	07/08/2007

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