MEDICARE: WILLIAM R WALDRON OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	0618000144	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2149623	OTHER	VA	AETNA U.S. HEALTHCARE
2	10997	OTHER	VA	AVESIS
3	381285	OTHER	VA	ANTHEM BLUE CROSS
4	56056	OTHER	VA	SENTARA
5	320-621	OTHER	VA	MAMSI
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	WA917852	OTHER	VA	CLARITY VISION

General Provider Information

NPI Number	:	1386640308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM R WALDRON OD

Provider Business Mailing Address
First Line	:	1215V GEORGE WASHINGTON MEMORIAL HWY
Second Line	:
City	:	YORKTOWN
State	:	VA
Zip	:	23693
Country	:	US
Telephone Number	:	757-596-5666
Fax Number	:	757-596-9755

Provider Business Practice Location Address
First Line	:	1215V GEORGE WASHINGTON MEMORIAL HWY
Second Line	:
City	:	YORKTOWN
State	:	VA
Zip	:	23693
Country	:	US
Telephone Number	:	757-596-5666
Fax Number	:	757-596-9755

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	03/09/2010

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