Provider Demographics
NPI:1205143252
Name:FRANKLIN, WILLIS NOELLE (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIS
Middle Name:NOELLE
Last Name:FRANKLIN
Suffix:
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 1:333 S WESTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-5519
Mailing Address - Country:US
Mailing Address - Phone:409-617-9774
Mailing Address - Fax:
Practice Address - Street 1:333 S WESTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-5519
Practice Address - Country:US
Practice Address - Phone:573-785-2853
Practice Address - Fax:573-729-2310
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-10
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010028684152W00000X
TX7597T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist