Provider Demographics
NPI:1164548921
Name:COX, WILLIAM D (BA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:D
Last Name:COX
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6767 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-3903
Mailing Address - Country:US
Mailing Address - Phone:402-393-8917
Mailing Address - Fax:
Practice Address - Street 1:6767 MAPLE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-3903
Practice Address - Country:US
Practice Address - Phone:402-393-8917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47-083536500Medicaid