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General NPI Number Information
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NPI Number | 1346556529
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Entity Type | Organization
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Legal Business Name | WILLIAM BOCK OD PA
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Dates
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Enumeration Date | 08/25/2010
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Last Update Date | 08/25/2010
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Provider Practice Location Address
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Address Line | 6745 N CHURCH AVE
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City | MULBERRY
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State | FL
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Zip | 33860-2080
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Country | US
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Telephone | 863-648-0222
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Fax | 863-648-0200
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Provider Business Mailing Address
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Address Line | PO BOX 6216
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City | LAKELAND
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State | FL
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Zip | 33807-6216
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Country | US
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Telephone | 863-648-0222
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Fax | 863-648-0200
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM C BOCK
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Credential | OD PA
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Telephone | 863-648-0222
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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 | OPC701
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License Number State | FL
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