Provider Demographics
NPI:1154451607
Name:FENSCH, WILLIAM STEPHEN (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:STEPHEN
Last Name:FENSCH
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 1:700 E CLEMENTS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RUNNEMEDE
Mailing Address - State:NJ
Mailing Address - Zip Code:08078-1455
Mailing Address - Country:US
Mailing Address - Phone:856-939-8000
Mailing Address - Fax:856-939-8001
Practice Address - Street 1:700 E CLEMENTS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:RUNNEMEDE
Practice Address - State:NJ
Practice Address - Zip Code:08078-1455
Practice Address - Country:US
Practice Address - Phone:856-939-8000
Practice Address - Fax:856-939-8001
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00362100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1955501Medicaid
NJ1955501Medicaid
NJ152934Medicare ID - Type Unspecified