MEDICARE: DR. DAVID WILLIAM FOX 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	OE-005935 T	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821028754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID WILLIAM FOX O.D.

Provider Business Mailing Address
First Line	:	127 MAIN ST
Second Line	:
City	:	WELLSBORO
State	:	PA
Zip	:	16901-1414
Country	:	US
Telephone Number	:	570-724-4756
Fax Number	:

Provider Business Practice Location Address
First Line	:	127 MAIN ST
Second Line	:
City	:	WELLSBORO
State	:	PA
Zip	:	16901-1414
Country	:	US
Telephone Number	:	570-724-4756
Fax Number	:

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	01/29/2015

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