Provider Demographics
NPI:1821091042
Name:NIMMONS, WILLIAM T (OD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:T
Last Name:NIMMONS
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 249
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29679-0249
Mailing Address - Country:US
Mailing Address - Phone:864-882-3338
Mailing Address - Fax:864-885-0349
Practice Address - Street 1:807 BY PASS 123
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-4759
Practice Address - Country:US
Practice Address - Phone:864-882-3338
Practice Address - Fax:864-885-0349
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC669152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD06697Medicaid
SCD06697Medicaid
SCU05243Medicare UPIN