Provider Demographics
NPI:1437329695
Name:WILLIAM O. WILLS OD
Entity Type:Organization
Organization Name:WILLIAM O. WILLS OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:O
Authorized Official - Last Name:WILLS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:540-371-9191
Mailing Address - Street 1:1823 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3530
Mailing Address - Country:US
Mailing Address - Phone:540-371-9191
Mailing Address - Fax:540-373-0017
Practice Address - Street 1:1823 CHARLES ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3530
Practice Address - Country:US
Practice Address - Phone:540-371-9191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000420152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA410000390Medicare PIN
VA0653010001Medicare NSC