Provider Demographics
NPI:1710082482
Name:AHDERS, WILLIAM G (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:G
Last Name:AHDERS
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 1:2401 AUGUSTA RD
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-4543
Mailing Address - Country:US
Mailing Address - Phone:803-794-1088
Mailing Address - Fax:803-794-1244
Practice Address - Street 1:119 LATONEA DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-7572
Practice Address - Country:US
Practice Address - Phone:803-798-8642
Practice Address - Fax:803-798-0422
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC704152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT235620281Medicaid
T235620281Medicare ID - Type Unspecified