Healthcare Provider Details

I. General information

NPI: 1144223405
Provider Name (Legal Business Name): WILLIAM JOSEPH PROTHERO O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1837 156TH AVE NE STE 201
BELLEVUE WA
98007-4387
US

IV. Provider business mailing address

1837 156TH AVE NE STE 201
BELLEVUE WA
98007-4387
US

V. Phone/Fax

Practice location:
  • Phone: 425-643-2020
  • Fax: 425-643-0859
Mailing address:
  • Phone: 425-643-2020
  • Fax: 425-643-0859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD00001765
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number9074
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: