Provider Demographics
NPI:1205048022
Name:MUNCEY, WILLIS SHERMAN (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIS
Middle Name:SHERMAN
Last Name:MUNCEY
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:9935 COORS BYPASS NW
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-6195
Mailing Address - Country:US
Mailing Address - Phone:505-899-8993
Mailing Address - Fax:505-899-8993
Practice Address - Street 1:9935 COORS BYPASS NW
Practice Address - Street 2:SUITE B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-6195
Practice Address - Country:US
Practice Address - Phone:505-899-8993
Practice Address - Fax:505-898-8994
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2011-01-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM2427152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist