=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083766638
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM H. VICKERS O. D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 215 NORTH ALLISON
-----------------------------------------------------
City | BARBOURVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-546-4166
-----------------------------------------------------
Fax | 606-546-4167
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P. O. BOX 400
-----------------------------------------------------
City | BARBOURVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40906-1336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-546-4166
-----------------------------------------------------
Fax | 606-546-4167
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | KY1002DT
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------