Provider Demographics
NPI:1083766638
Name:VICKERS, WILLIAM H (O D)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:H
Last Name:VICKERS
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 400
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-1336
Mailing Address - Country:US
Mailing Address - Phone:606-546-4166
Mailing Address - Fax:606-546-4167
Practice Address - Street 1:215 NORTH ALLISON
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906
Practice Address - Country:US
Practice Address - Phone:606-546-4166
Practice Address - Fax:606-546-4167
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY1002DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77010023Medicaid
KY1851601Medicare ID - Type UnspecifiedMEDICARE SATELLITE OFFICE
KY9206701Medicare ID - Type UnspecifiedMEDICARE