=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124086319
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM EDWARD FOX III OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2006
-----------------------------------------------------
Last Update Date | 05/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 642 FRIENDLY CENTER RD
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27408-7804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-726-4775
-----------------------------------------------------
Fax | 919-573-9554
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3820 GLEN IRIS LN
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27612-4278
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-726-4775
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 1068
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------