Provider Demographics
NPI:1225161094
Name:MISNER, WILLIAM ALBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ALBERT
Last Name:MISNER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:BERT
Other - Middle Name:
Other - Last Name:MISNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:1110 BAYWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MALABAR
Mailing Address - State:FL
Mailing Address - Zip Code:32950-3359
Mailing Address - Country:US
Mailing Address - Phone:321-984-3494
Mailing Address - Fax:
Practice Address - Street 1:1040 MALABAR RD SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-3251
Practice Address - Country:US
Practice Address - Phone:321-984-3494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2199152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT93951Medicare UPIN
FL19671Medicare ID - Type Unspecified