Provider Demographics
NPI:1568428688
Name:FORSE, WILLIAM R (OD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:FORSE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 524
Mailing Address - Street 2:
Mailing Address - City:MC ELHATTAN
Mailing Address - State:PA
Mailing Address - Zip Code:17748-0524
Mailing Address - Country:US
Mailing Address - Phone:570-769-2877
Mailing Address - Fax:570-769-2879
Practice Address - Street 1:1 OUTLET LN
Practice Address - Street 2:SUITE 310
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-9794
Practice Address - Country:US
Practice Address - Phone:570-769-2877
Practice Address - Fax:570-769-2879
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000027152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1900886OtherHIGHMARK BLUE SHIELD
PA75790 163HOtherGEISINGER
PA001863439Medicaid
PAU87466Medicare UPIN
PA001863439Medicaid
PA75790 163HOtherGEISINGER