Provider Demographics
NPI:1851454508
Name:DOVER, WILLIAM G (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:G
Last Name:DOVER
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 1:535 W WHEATLAND RD
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-4515
Mailing Address - Country:US
Mailing Address - Phone:972-298-7249
Mailing Address - Fax:972-298-6740
Practice Address - Street 1:535 W WHEATLAND RD
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4515
Practice Address - Country:US
Practice Address - Phone:972-298-7249
Practice Address - Fax:972-298-6740
Is Sole Proprietor?:No
Enumeration Date:2006-12-17
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02097T152W00000X, 152WC0802X, 152WP0200X, 152WS0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E52GOtherGROUP BCBS NUMBER
TX019709702Medicaid
TX021948OtherBLOCK MEDICAID LOC #
TX80315EOtherINDIVIDUAL BCBS NUMBER
TX176941602Medicaid
TX921410OtherBLOCK MEDICAID NUMBER
TXT13054Medicare UPIN
TX00E52GMedicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
TX00E52GOtherGROUP BCBS NUMBER
TX021948OtherBLOCK MEDICAID LOC #