MEDICARE: WILLIAM RUSSELL MORTON 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
1	152W00000X	Optometrist	18001573B	IN

General Provider Information

NPI Number	:	1598749475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM RUSSELL MORTON O.D.

Provider Business Mailing Address
First Line	:	2516 COVINGTON ST
Second Line	:
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47906-1404
Country	:	US
Telephone Number	:	765-463-4558
Fax Number	:	765-497-2154

Provider Business Practice Location Address
First Line	:	2516 COVINGTON ST
Second Line	:
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47906-1404
Country	:	US
Telephone Number	:	765-463-4558
Fax Number	:	765-497-2154

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

Provider Enumeration Date	:	12/03/2005
Last Update Date	:	05/15/2008

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