MEDICARE: DAVID A WILLINGHAM 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	2648T	TX

General Provider Information

NPI Number	:	1750312120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID A WILLINGHAM O.D.

Provider Business Mailing Address
First Line	:	3200 N MACARTHUR BLVD
Second Line	:	SUITE 200
City	:	IRVING
State	:	TX
Zip	:	75062-4453
Country	:	US
Telephone Number	:	972-258-7979
Fax Number	:	972-570-5502

Provider Business Practice Location Address
First Line	:	3200 N MACARTHUR BLVD
Second Line	:	SUITE 200
City	:	IRVING
State	:	TX
Zip	:	75062-4453
Country	:	US
Telephone Number	:	972-258-7979
Fax Number	:	972-570-5502

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	07/08/2007

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