Provider Demographics
NPI:1265729354
Name:SULLIVAN, WILLIAM EUGENE (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:EUGENE
Last Name:SULLIVAN
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 1:6511 SULLY LANE PR
Mailing Address - Street 2:
Mailing Address - City:WEST RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99353-8002
Mailing Address - Country:US
Mailing Address - Phone:206-200-6968
Mailing Address - Fax:
Practice Address - Street 1:6511 SULLY LANE PR
Practice Address - Street 2:
Practice Address - City:WEST RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99353-8002
Practice Address - Country:US
Practice Address - Phone:206-200-6968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-09
Last Update Date:2011-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60233648152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist