Provider Demographics
NPI:1124005707
Name:VANZETTA, WILLIAM J (OD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:VANZETTA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-594-4006
Mailing Address - Fax:757-534-5190
Practice Address - Street 1:11800 ROCK LANDING DR
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4206
Practice Address - Country:US
Practice Address - Phone:757-643-8800
Practice Address - Fax:757-643-8919
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0601001475152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1124005707Medicaid
VA015380R53Medicare PIN
VA1124005707Medicaid
VA080100235Medicare PIN