Provider Demographics
NPI:1235241464
Name:EVERETT, WILLIAM C (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:C
Last Name:EVERETT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:120 COMMERCE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-1890
Mailing Address - Country:US
Mailing Address - Phone:912-265-8852
Mailing Address - Fax:912-264-4673
Practice Address - Street 1:120 COMMERCE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-1890
Practice Address - Country:US
Practice Address - Phone:912-265-8852
Practice Address - Fax:912-264-4673
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA684152W00000X, 152WC0802X, 152WL0500X, 152WV0400X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA582398109OtherSTAY FOCUSED EYECARE
GA1222850001OtherDEMERC
GA410000715OtherRAILROAD MEDICARE
GA000003803AMedicaid
GA000003803AMedicaid
GAT97480Medicare UPIN
GA582398109OtherSTAY FOCUSED EYECARE