Provider Demographics
NPI:1790175479
Name:ARNOLD, WILLIAM LESLIE (O,D,)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LESLIE
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:O,D,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 COLONY CROSSING WAY STE 220
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-6834
Mailing Address - Country:US
Mailing Address - Phone:601-605-4402
Mailing Address - Fax:
Practice Address - Street 1:111 COLONY CROSSING WAY STE 220
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6834
Practice Address - Country:US
Practice Address - Phone:601-605-4402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS918152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist