Provider Demographics
NPI:1184849077
Name:ATHEY, WILLIAM B (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:B
Last Name:ATHEY
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3808 28TH AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-1288
Mailing Address - Country:US
Mailing Address - Phone:308-865-2757
Mailing Address - Fax:308-865-2758
Practice Address - Street 1:3808 28TH AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-1288
Practice Address - Country:US
Practice Address - Phone:308-865-2757
Practice Address - Fax:308-865-2758
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE26981ABOC156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025321800Medicaid
NE5605760001Medicare NSC