Provider Demographics
NPI:1982852760
Name:WILLIAM DROST ALTIG, O.D., P.C.
Entity Type:Organization
Organization Name:WILLIAM DROST ALTIG, O.D., P.C.
Other - Org Name:ALTIG OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DROST
Authorized Official - Last Name:ALTIG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:817-847-0030
Mailing Address - Street 1:3451 WESTERN CENTER BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-1937
Mailing Address - Country:US
Mailing Address - Phone:817-847-0030
Mailing Address - Fax:817-847-1478
Practice Address - Street 1:3451 WESTERN CENTER BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137
Practice Address - Country:US
Practice Address - Phone:817-847-0030
Practice Address - Fax:817-847-1478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3438TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0192262-01Medicaid
TX00E14MOtherBC/BS OF TX
TX1139150001Medicare NSC
DP2311Medicare PIN
TX0A4673Medicare PIN