Provider Demographics
NPI:1386640308
Name:WALDRON, WILLIAM R (OD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:WALDRON
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 1:1215V GEORGE WASHINGTON MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693
Mailing Address - Country:US
Mailing Address - Phone:757-596-5666
Mailing Address - Fax:757-596-9755
Practice Address - Street 1:1215V GEORGE WASHINGTON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23693
Practice Address - Country:US
Practice Address - Phone:757-596-5666
Practice Address - Fax:757-596-9755
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000144152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2149623OtherAETNA U.S. HEALTHCARE
VA10997OtherAVESIS
VA381285OtherANTHEM BLUE CROSS
VA56056OtherSENTARA
VA320-621OtherMAMSI
VA009235281Medicaid
VAWA917852OtherCLARITY VISION
VAWA917852OtherCLARITY VISION
VA10997OtherAVESIS