Healthcare Provider Details

I. General information

NPI: 1215035480
Provider Name (Legal Business Name): WILLIAM DAVID POOL OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 NW 1ST STREET
GALVA IL
61434
US

IV. Provider business mailing address

216 NW 1ST STREET
GALVA IL
61434
US

V. Phone/Fax

Practice location:
  • Phone: 309-932-3615
  • Fax: 309-932-2023
Mailing address:
  • Phone: 309-932-3615
  • Fax: 309-932-2023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046007644
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: