Provider Demographics
NPI:1720310477
Name:PADGETT, WILLIAM C (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:C
Last Name:PADGETT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:CAM
Other - Middle Name:
Other - Last Name:PADGETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1302 BROWN ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-4672
Mailing Address - Country:US
Mailing Address - Phone:252-946-7257
Mailing Address - Fax:252-946-9497
Practice Address - Street 1:1302 BROWN ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-4672
Practice Address - Country:US
Practice Address - Phone:252-946-7257
Practice Address - Fax:252-946-9497
Is Sole Proprietor?:No
Enumeration Date:2010-02-05
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0869152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909684Medicaid
NC8909684Medicaid