Provider Demographics
NPI:1801860580
Name:AXSON, WILLIAM ALAN (MD JD FCLM)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ALAN
Last Name:AXSON
Suffix:
Gender:M
Credentials:MD JD FCLM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1435
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29679
Mailing Address - Country:US
Mailing Address - Phone:864-882-7845
Mailing Address - Fax:864-882-7822
Practice Address - Street 1:304-123 BYPASS
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678
Practice Address - Country:US
Practice Address - Phone:864-882-7845
Practice Address - Fax:864-882-7822
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9889207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC223204Medicaid
SC223204Medicaid
SC2349Medicare PIN