Provider Demographics
NPI:1376863969
Name:WHALLEY, WILLIAM A (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:A
Last Name:WHALLEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 465
Mailing Address - Street 2:
Mailing Address - City:HALEIWA
Mailing Address - State:HI
Mailing Address - Zip Code:96712-0465
Mailing Address - Country:US
Mailing Address - Phone:808-674-8811
Mailing Address - Fax:808-674-8899
Practice Address - Street 1:579 FARRINGTON HWY
Practice Address - Street 2:#101
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2027
Practice Address - Country:US
Practice Address - Phone:808-674-8811
Practice Address - Fax:808-674-8899
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-04
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI721152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist