Provider Demographics
NPI:1043274327
Name:WATERBURY, WILLIAM FRANCIS II (OD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:FRANCIS
Last Name:WATERBURY
Suffix:II
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 N. HELMER RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49037-7931
Mailing Address - Country:US
Mailing Address - Phone:269-963-5640
Mailing Address - Fax:269-963-1666
Practice Address - Street 1:228 N. HELMER RD.
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MI
Practice Address - Zip Code:49037-7931
Practice Address - Country:US
Practice Address - Phone:269-963-5640
Practice Address - Fax:269-963-1666
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003906152W00000X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4723594Medicaid
V04534Medicare UPIN
MIV04534Medicare UPIN