Provider Demographics
NPI:1922484708
Name:WARD, WILLIAM JASON (OD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JASON
Last Name:WARD
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 1:4934 UPTON TALLEY RD
Mailing Address - Street 2:
Mailing Address - City:UPTON
Mailing Address - State:KY
Mailing Address - Zip Code:42784-9336
Mailing Address - Country:US
Mailing Address - Phone:270-737-0055
Mailing Address - Fax:270-763-0050
Practice Address - Street 1:100 WALMART DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-5548
Practice Address - Country:US
Practice Address - Phone:270-737-0055
Practice Address - Fax:270-763-0050
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2003DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist