Healthcare Provider Details

I. General information

NPI: 1144176371
Provider Name (Legal Business Name): GUY WILLIAM LONDON OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1872 NORWOOD DR
HURST TX
76054-3099
US

IV. Provider business mailing address

3301 SW 58TH AVE APT 5103
AMARILLO TX
79118-1319
US

V. Phone/Fax

Practice location:
  • Phone: 817-768-6620
  • Fax:
Mailing address:
  • Phone: 325-665-8517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11610TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: