Provider Demographics
NPI:1295827178
Name:TOMASIK, WILLIAM J (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:TOMASIK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:BILL
Other - Middle Name:J
Other - Last Name:TOMASIK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:136 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1715
Mailing Address - Country:US
Mailing Address - Phone:304-842-4223
Mailing Address - Fax:
Practice Address - Street 1:136 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1715
Practice Address - Country:US
Practice Address - Phone:304-842-4223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV745-D152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0149430000Medicaid
WVT32590Medicare UPIN
WV0149430000Medicaid
WV0811260001Medicare NSC