Provider Demographics
NPI:1538320163
Name:WILLIAM W TOWNSEND OD PC
Entity Type:Organization
Organization Name:WILLIAM W TOWNSEND OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:WALLACE
Authorized Official - Last Name:TOWNSEND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:757-463-0000
Mailing Address - Street 1:4224 HOLLAND ROAD
Mailing Address - Street 2:108
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1900
Mailing Address - Country:US
Mailing Address - Phone:757-463-0000
Mailing Address - Fax:757-631-0260
Practice Address - Street 1:4224 HOLLAND ROAD
Practice Address - Street 2:108
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1900
Practice Address - Country:US
Practice Address - Phone:757-463-0000
Practice Address - Fax:757-631-0260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000189152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009203001Medicaid
VAVAA103607Medicare PIN
VA009203001Medicaid
VAT21799Medicare UPIN