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General NPI Number Information
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NPI Number | 1508964180
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Entity Type | Individual
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Provider Name | WILLIAM A PELLOW X OD
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 10/02/2012
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Provider Practice Location Address
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Address Line | 90 N CLARK AVE UNIT 3
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City | REPUBLIC
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State | WA
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Zip | 99166-5024
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Country | US
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Telephone | 509-775-3800
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Fax | 509-775-3994
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Provider Business Mailing Address
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Address Line | PO BOX 409
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City | REPUBLIC
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State | WA
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Zip | 99166-0409
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Country | US
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Telephone | 509-775-3800
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Fax | 509-775-3994
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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 | 1669TX
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License Number State | WA
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