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General NPI Number Information
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NPI Number | 1760517882
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Entity Type | Individual
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Provider Name | WILLIAM THEODORE O.D.
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Gender | Male
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2747 GULF TO BAY BLVD
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City | CLEARWATER
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State | FL
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Zip | 33759-3945
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Country | US
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Telephone | 727-431-0234
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Fax |
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Provider Business Mailing Address
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Address Line | 218 WESTWINDS DR
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City | PALM HARBOR
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State | FL
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Zip | 34683-1038
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Country | US
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Telephone |
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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 | OPC2398
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License Number State | FL
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