Provider Demographics
NPI:1205834645
Name:POTTER, WILLIAM S (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:S
Last Name:POTTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4 DEARFIELD DR
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-5351
Mailing Address - Country:US
Mailing Address - Phone:203-869-3082
Mailing Address - Fax:203-869-6453
Practice Address - Street 1:4 DEARFIELD DR
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831-5351
Practice Address - Country:US
Practice Address - Phone:203-869-3082
Practice Address - Fax:203-869-6453
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT030761207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
533386OtherAETNA
60K731OtherEMPIRE
010030761CT05OtherANTHEM BCBS
2V8864OtherHEALTHNET
030761OtherCONNECTICARE
010030761CT05OtherANTHEM BCBS
0481650001Medicare NSC
2V8864OtherHEALTHNET