Provider Demographics
NPI:1093867236
Name:COLE, WILLIAM A (OD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:COLE
Suffix:
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:PO BOX 226
Mailing Address - Street 2:
Mailing Address - City:HIGH SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32655-0226
Mailing Address - Country:US
Mailing Address - Phone:386-454-1687
Mailing Address - Fax:
Practice Address - Street 1:2133 W US HIGHWAY 90
Practice Address - Street 2:SUITE 170
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-4705
Practice Address - Country:US
Practice Address - Phone:386-755-2400
Practice Address - Fax:386-755-2400
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3103152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000E0378Medicare ID - Type Unspecified
FLU69743Medicare UPIN