Provider Demographics
NPI:1326403551
Name:ONEILL, WILLIAM THOMAS JR (PO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:THOMAS
Last Name:ONEILL
Suffix:JR
Gender:M
Credentials:PO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8757 SE SANDY LN
Mailing Address - Street 2:
Mailing Address - City:HOBE SOUND
Mailing Address - State:FL
Mailing Address - Zip Code:33455-4644
Mailing Address - Country:US
Mailing Address - Phone:602-348-1055
Mailing Address - Fax:
Practice Address - Street 1:3825 W ANTHEM WAY
Practice Address - Street 2:UNIT 3151
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-3100
Practice Address - Country:US
Practice Address - Phone:602-348-1055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-14
Last Update Date:2021-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ335E00000X
FLPOR351335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier