=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396937983
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILLIAM R. WALDRON
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2007
-----------------------------------------------------
Last Update Date | 05/09/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1215 GEORGE WASHINGTON MEM HWY SUITE V
-----------------------------------------------------
City | YORKTOWN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23693-4316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-596-5666
-----------------------------------------------------
Fax | 757-596-9755
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1215 GEORGE WASHINGTON MEM HWY SUITE V
-----------------------------------------------------
City | YORKTOWN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23693-4316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-596-5666
-----------------------------------------------------
Fax | 757-596-9755
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. WILLIAM R WALDRON
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 757-596-5666
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 0618000144
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------