Provider Demographics
NPI:1629153796
Name:DOWNEY, WILLIAM ARTHUR (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ARTHUR
Last Name:DOWNEY
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 1:3637 LARCH AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-8448
Mailing Address - Country:US
Mailing Address - Phone:530-544-3403
Mailing Address - Fax:530-544-4032
Practice Address - Street 1:3637 LARCH AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-8448
Practice Address - Country:US
Practice Address - Phone:530-544-3403
Practice Address - Fax:530-544-4032
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA006201T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0062010Medicare PIN
T10261Medicare UPIN
0283680001Medicare NSC