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General NPI Number Information
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NPI Number | 1477934057
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Entity Type | Individual
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Provider Name | WILLIAM LEE THIBODEAUX O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/09/2015
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Last Update Date | 01/19/2016
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Provider Practice Location Address
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Address Line | 2349 DANVILLE RD SW SUITE 410
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City | DECATUR
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State | AL
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Zip | 35603-4284
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Country | US
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Telephone | 256-353-2392
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Fax |
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Provider Business Mailing Address
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Address Line | 1604 VESTAVIA DR SW
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City | DECATUR
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State | AL
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Zip | 35603-4635
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Country | US
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Telephone | 256-466-6229
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Fax |
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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 | S-D41-TA-A26
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License Number State | AL
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