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General NPI Number Information
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NPI Number | 1285621656
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Entity Type | Individual
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Provider Name | WILLIAM FIX O.D.
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Gender | Male
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Dates
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Enumeration Date | 09/30/2005
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Last Update Date | 10/01/2008
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Provider Practice Location Address
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Address Line | 321 S PARK AVE
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City | HERRIN
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State | IL
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Zip | 62948-3603
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Country | US
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Telephone | 618-942-2900
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Fax | 618-942-4199
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Provider Business Mailing Address
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Address Line | 1200 W DEYOUNG ST
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City | MARION
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State | IL
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Zip | 62959-4437
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Country | US
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Telephone | 618-993-5686
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Fax | 618-997-6250
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046-007446
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License Number State | IL
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