Provider Demographics
NPI:1568579969
Name:GEORGE, WILLIAM S (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:S
Last Name:GEORGE
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 1:3674 HAMILTON KY
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-6466
Mailing Address - Country:US
Mailing Address - Phone:561-681-7801
Mailing Address - Fax:561-478-2609
Practice Address - Street 1:3200 OLD BOYNTON RD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-6506
Practice Address - Country:US
Practice Address - Phone:561-737-0510
Practice Address - Fax:561-478-2609
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3586152W00000X
GA1977152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20008YMedicare ID - Type Unspecified
FL20008ZMedicare ID - Type Unspecified
FLU93225Medicare UPIN