Provider Demographics
NPI:1659473023
Name:POWELL, WILLIAM MITCHELL (DOCTOR OF OPTOMETRY)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MITCHELL
Last Name:POWELL
Suffix:
Gender:M
Credentials:DOCTOR OF OPTOMETRY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 BUTLER RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405
Mailing Address - Country:US
Mailing Address - Phone:540-373-3021
Mailing Address - Fax:540-373-5565
Practice Address - Street 1:230 BUTLER RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22405
Practice Address - Country:US
Practice Address - Phone:540-373-3021
Practice Address - Fax:540-373-5565
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000447152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA210946OtherOPTIMUM CHOICE MDIPA MAMS
VA210948OtherOPTIMUM CHOICE MDIPA MAMS
VA061203OtherANTHEM BCBS
VA9203915Medicaid
VAA01995OtherEYEMED/BLUEVIEW
VA210946OtherOPTIMUM CHOICE MDIPA MAMS
VA210948OtherOPTIMUM CHOICE MDIPA MAMS
T21372Medicare UPIN
VA9203915Medicaid