Healthcare Provider Details

I. General information

NPI: 1891022257
Provider Name (Legal Business Name): MR. WILLIAM RICHARD WHITTEN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2009
Last Update Date: 11/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 CLEMENT ST
SAN FRANCISCO CA
94121-1545
US

IV. Provider business mailing address

4150 CLEMENT ST
SAN FRANCISCO CA
94121-1545
US

V. Phone/Fax

Practice location:
  • Phone: 415-221-4810
  • Fax: 415-379-5590
Mailing address:
  • Phone: 415-221-4810
  • Fax: 415-379-5590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: