Provider Demographics
NPI:1689709834
Name:DYKE, WILLIAM JR (OD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:DYKE
Suffix:JR
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 1:351 SPRINGFIELD ST
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-1935
Mailing Address - Country:US
Mailing Address - Phone:413-596-3615
Mailing Address - Fax:413-596-3615
Practice Address - Street 1:1907 WILBRAHAM RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01129-1822
Practice Address - Country:US
Practice Address - Phone:413-796-7572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2597152W00000X
AZ904152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA431058Medicare PIN