Provider Demographics
NPI:1740230663
Name:WEBB, BILL D (OD)
Entity Type:Individual
Prefix:DR
First Name:BILL
Middle Name:D
Last Name:WEBB
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:PO BOX 415
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42276-0415
Mailing Address - Country:US
Mailing Address - Phone:270-726-2434
Mailing Address - Fax:270-726-2435
Practice Address - Street 1:603 E 4TH ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-1857
Practice Address - Country:US
Practice Address - Phone:270-726-2434
Practice Address - Fax:270-726-2435
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY716DT152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77007169Medicaid
KYT54585Medicare UPIN
KY9034101Medicare PIN