Provider Demographics
NPI:1295812394
Name:LIVINGSTON, WILLIAM HENRY (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:HENRY
Last Name:LIVINGSTON
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 1:18 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945-1926
Mailing Address - Country:US
Mailing Address - Phone:781-639-0090
Mailing Address - Fax:
Practice Address - Street 1:336 WALNUT ST
Practice Address - Street 2:
Practice Address - City:NEWTONVILLE
Practice Address - State:MA
Practice Address - Zip Code:02460-1923
Practice Address - Country:US
Practice Address - Phone:617-964-9666
Practice Address - Fax:617-964-3380
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2719152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA460314OtherTUFTS
MA37962OtherDAVIS VISION
MA0335118Medicaid
MA600000009OtherHARVARD PILGRIM
MALIW15558OtherBLUE CROSS BLUE SHIELD
MA37962OtherDAVIS VISION
MA600000009OtherHARVARD PILGRIM