Healthcare Provider Details

I. General information

NPI: 1366409112
Provider Name (Legal Business Name): WILLIAM J COTTONE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 12/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4171 TAMIAMI TRL S # 34
VENICE FL
34293-5111
US

IV. Provider business mailing address

1504 FRANKLIN LN
NORTH PORT FL
34286-7683
US

V. Phone/Fax

Practice location:
  • Phone: 941-492-9181
  • Fax: 941-306-4786
Mailing address:
  • Phone: 941-423-1107
  • Fax: 941-764-7383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC2505
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOP 2505
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: