Provider Demographics
NPI:1609053784
Name:WILLIAM M DAVIDSON PC
Entity Type:Organization
Organization Name:WILLIAM M DAVIDSON PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:334-222-8561
Mailing Address - Street 1:PO BOX 1458
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-1225
Mailing Address - Country:US
Mailing Address - Phone:334-222-8561
Mailing Address - Fax:334-222-5032
Practice Address - Street 1:500 WESTGATE PLZ
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-2525
Practice Address - Country:US
Practice Address - Phone:334-222-8561
Practice Address - Fax:334-222-5032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-355-TA-027332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL5113470001Medicare NSC