Provider Demographics
NPI:1447235882
Name:ROSCOE, WILLIAM DOUGLAS (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DOUGLAS
Last Name:ROSCOE
Suffix:
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 3517
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27331-3517
Mailing Address - Country:US
Mailing Address - Phone:919-776-2712
Mailing Address - Fax:919-775-3486
Practice Address - Street 1:420 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332-5924
Practice Address - Country:US
Practice Address - Phone:919-776-2712
Practice Address - Fax:919-775-3486
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0969152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC410004244OtherRAILROAD MEDICARE
NC7909776Medicaid
83700OtherSPECTERA
NC09776OtherBCBS
NC09776OtherBCBS
NC410004244OtherRAILROAD MEDICARE