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General NPI Number Information
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NPI Number | 1902970973
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Entity Type | Organization
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Legal Business Name | WILLIAM SAMUEL ASHLEY, O.D.
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 11/27/2007
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Provider Practice Location Address
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Address Line | 1010 JOHNSON ST
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City | TALLULAH
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State | LA
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Zip | 71282-5216
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Country | US
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Telephone | 318-574-2369
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Fax | 318-574-1111
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Provider Business Mailing Address
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Address Line | 1010 JOHNSON ST
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City | TALLULAH
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State | LA
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Zip | 71282-5216
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Country | US
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Telephone | 318-574-2369
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Fax | 318-574-1111
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILLIAM SAMUEL ASHLEY
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Credential | O.D.
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Telephone | 318-574-2369
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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 | 855-135 T
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License Number State | LA
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