Provider Demographics
NPI:1184617292
Name:RISINGER, WILLIAM C JR (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:C
Last Name:RISINGER
Suffix:JR
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 1:3908 PARLIAMENT DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3015
Mailing Address - Country:US
Mailing Address - Phone:318-445-5319
Mailing Address - Fax:
Practice Address - Street 1:3908 PARLIAMENT DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3015
Practice Address - Country:US
Practice Address - Phone:318-445-5319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA723-001T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1143936Medicaid
LA49406Medicare PIN
LAT19640Medicare UPIN
LA1143936Medicaid
LA0272780001Medicare NSC