Provider Demographics
NPI:1881770477
Name:PADULA, WILLIAM V (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:V
Last Name:PADULA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:37 SOUNDVIEW RD
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2916
Mailing Address - Country:US
Mailing Address - Phone:203-453-2222
Mailing Address - Fax:203-458-3463
Practice Address - Street 1:37 SOUNDVIEW RD
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437
Practice Address - Country:US
Practice Address - Phone:203-453-2222
Practice Address - Fax:203-458-3463
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000858152WS0006X, 152WV0400X, 152WP0200X
CT858152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT410000299Medicare PIN
CTT22377Medicare UPIN