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General NPI Number Information
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NPI Number | 1295867703
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Entity Type | Organization
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Legal Business Name | WM DWAYNE SIZEMORE OD PSC
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Dates
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Enumeration Date | 03/10/2007
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Last Update Date | 08/27/2008
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Provider Practice Location Address
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Address Line | 29 MAPLE ST
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City | WHITESBURG
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State | KY
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Zip | 41858-7494
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Country | US
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Telephone | 606-633-5200
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Fax | 606-633-1500
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Provider Business Mailing Address
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Address Line | 29 MAPLE ST
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City | WHITESBURG
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State | KY
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Zip | 41858-7494
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Country | US
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Telephone | 606-633-5200
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Fax | 606-633-1500
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILLIAM DWAYNE SIZEMORE
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Credential | O.D.
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Telephone | 606-633-5200
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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 | 968DT
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License Number State | KY
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