Healthcare Provider Details

I. General information

NPI: 1205979242
Provider Name (Legal Business Name): WILLIAM ALLEN HERREN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MILL CREEK CIRCLE
POOLER GA
31322
US

IV. Provider business mailing address

831 E 1ST ST
MIDWAY GA
31320-7240
US

V. Phone/Fax

Practice location:
  • Phone: 912-748-9646
  • Fax: 912-748-9664
Mailing address:
  • Phone: 912-884-5556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number881
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number881
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number881
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: