Provider Demographics
NPI:1972514560
Name:DERR, WILLIAM V (OD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:V
Last Name:DERR
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:299 CAREW ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104
Mailing Address - Country:US
Mailing Address - Phone:413-736-1833
Mailing Address - Fax:413-781-1899
Practice Address - Street 1:299 CAREW ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104
Practice Address - Country:US
Practice Address - Phone:413-736-1833
Practice Address - Fax:413-781-1899
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA4300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0337561Medicaid
U90879Medicare UPIN
MA0337561Medicaid