Healthcare Provider Details

I. General information

NPI: 1043274327
Provider Name (Legal Business Name): WILLIAM FRANCIS WATERBURY II O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 N. HELMER RD.
SPRINGFIELD MI
49037-7931
US

IV. Provider business mailing address

228 N. HELMER RD
SPRINGFIELD MI
49037-7931
US

V. Phone/Fax

Practice location:
  • Phone: 269-963-5640
  • Fax: 269-963-1666
Mailing address:
  • Phone: 269-963-5640
  • Fax: 269-963-1666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901003906
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number4901003906
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: