Provider Demographics
NPI:1144223405
Name:PROTHERO, WILLIAM JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:PROTHERO
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 1:1837 156TH AVE NE
Mailing Address - Street 2:STE 201
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-4387
Mailing Address - Country:US
Mailing Address - Phone:425-643-2020
Mailing Address - Fax:425-643-0859
Practice Address - Street 1:1837 156TH AVE NE
Practice Address - Street 2:STE 201
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-4387
Practice Address - Country:US
Practice Address - Phone:425-643-2020
Practice Address - Fax:425-643-0859
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001765152W00000X
CA9074152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0103457OtherWA WORKERS COMP ID
WA2016038Medicaid
WA8469PROtherREGENCE WA BS
WA8469PROtherREGENCE WA BS
WA6478610001Medicare NSC
WA8469PROtherREGENCE WA BS
WAMP0709759OtherDEA NUMBER