Provider Demographics
NPI:1326082207
Name:ROSCOE, WILLIAM DON JR (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DON
Last Name:ROSCOE
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 544
Mailing Address - Street 2:
Mailing Address - City:SILER CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27344
Mailing Address - Country:US
Mailing Address - Phone:919-663-3033
Mailing Address - Fax:919-742-4698
Practice Address - Street 1:14215 US HWY 64 WEST
Practice Address - Street 2:
Practice Address - City:SILER CITY
Practice Address - State:NC
Practice Address - Zip Code:27344
Practice Address - Country:US
Practice Address - Phone:919-663-3033
Practice Address - Fax:919-742-4698
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1102152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2280129OtherMEDICARE COMPLETE
561378754OtherSUPERIOR
05526OtherSPECTERA
2280129OtherUNITED HEALTH CARE
51365OtherDAVIS VISION
NC8909789Medicaid
51365OtherDAVIS VISION
NC8909789Medicaid