Provider Demographics
NPI:1619247913
Name:WILLIAM H. VICKERS, OD PLLC
Entity Type:Organization
Organization Name:WILLIAM H. VICKERS, OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:VICKERS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:606-546-4166
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-0400
Mailing Address - Country:US
Mailing Address - Phone:606-546-4166
Mailing Address - Fax:606-546-4167
Practice Address - Street 1:215 N ALLISON AVE
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-1336
Practice Address - Country:US
Practice Address - Phone:606-546-4166
Practice Address - Fax:606-546-4167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY 1002 DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty