Provider Demographics
NPI:1518046523
Name:WACHS, WILLIAM W (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:W
Last Name:WACHS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:W
Other - Middle Name:W
Other - Last Name:W
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:218 MAIN ST
Mailing Address - City:IRVINE
Mailing Address - State:KY
Mailing Address - Zip Code:40336
Mailing Address - Country:US
Mailing Address - Phone:606-723-2505
Mailing Address - Fax:606-723-2505
Practice Address - Street 1:154 PATCHEN DR
Practice Address - Street 2:SUITE 71
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-4418
Practice Address - Country:US
Practice Address - Phone:859-268-1215
Practice Address - Fax:859-268-1215
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY939DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77009397Medicaid
KY77009397Medicaid
MW0230704OtherDEA
KY77009397Medicaid
KY0435050002Medicare NSC
9166801Medicare PIN
MW0230704OtherDEA
KYT54665Medicare UPIN