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NPI Code Detail

MEDICARE: DR. WILLIAM CHARLES PIKE O.D.

MEDICARE: DR. WILLIAM CHARLES PIKE O.D.
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
1152W00000XOptometrist2642FL

General Provider Information

NPI Number : 1467574392
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WILLIAM CHARLES PIKE O.D.
Provider Business Mailing Address
First Line : 2014 TUPELO CT
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-8801
Country : US
Telephone Number : 850-522-5030
Fax Number :
Provider Business Practice Location Address
First Line : 10270 FRONT BEACH RD
Second Line :
City : PANAMA CITY BEACH
State : FL
Zip : 32407-3808
Country : US
Telephone Number : 850-234-5340
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2007
Last Update Date : 07/08/2007

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