Provider Demographics
NPI:1023233285
Name:DAVIES, WILLIAM B (LO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:B
Last Name:DAVIES
Suffix:
Gender:M
Credentials:LO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:553 POST RD
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-3609
Mailing Address - Country:US
Mailing Address - Phone:203-655-9571
Mailing Address - Fax:203-655-0774
Practice Address - Street 1:553 POST RD
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-3609
Practice Address - Country:US
Practice Address - Phone:203-655-9571
Practice Address - Fax:203-655-0774
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTLO 720156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1215103320OtherSUPPLIER NPI
CT1215103320OtherSUPPLIER NPI