MEDICARE: DR. WILLIAM JOHN 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	TUV005582-1	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	410042275	OTHER	NY	MEDICARE RAILROAD
14	P00704467	OTHER	NY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1978856	OTHER	NY	UNITED HEALTH CARE
2	5884010	OTHER	NY	AETNA
3	00020934002	OTHER	NY	UNIVERA
4	010806583	OTHER	NY	NOVA
5	161578122	OTHER	NY	NORTH AMERICAN PREFERRED
7	146065CS	OTHER	NY	PREFERRED CARE
8	251744484	OTHER	NY	NORTH AMERICAN PREFERRED
9	7290085	OTHER	NY	INDEPENDENT HEALTH
10	9382749	OTHER	NY	PHCS
11	161578122	OTHER	NY	EMPIRE - UNITED HEATLHCAR
12	251744484	OTHER	NY	EMPIRE - UNITED HEALTHCAR
13	NY5582	OTHER	NY	EYEMED
15	000390107004	OTHER	NY	BLUE CROSS/ BLUE SHIELD

General Provider Information

NPI Number	:	1396740312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM JOHN WALDRON OD

Provider Business Mailing Address
First Line	:	2099 GRAND ISLAND BLVD
Second Line	:	STE A
City	:	GRAND ISLAND
State	:	NY
Zip	:	14072-2169
Country	:	US
Telephone Number	:	716-773-7653
Fax Number	:	716-773-3187

Provider Business Practice Location Address
First Line	:	2099 GRAND ISLAND BLVD
Second Line	:	STE A
City	:	GRAND ISLAND
State	:	NY
Zip	:	14072-2169
Country	:	US
Telephone Number	:	716-773-7653
Fax Number	:	716-773-3187

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	08/27/2019

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