Provider Demographics
NPI:1932217361
Name:WILLS, GEOFFREY FORREST (OD)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:FORREST
Last Name:WILLS
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 1:118 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTESANO
Mailing Address - State:WA
Mailing Address - Zip Code:98563-3709
Mailing Address - Country:US
Mailing Address - Phone:360-249-3485
Mailing Address - Fax:360-249-2747
Practice Address - Street 1:118 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTESANO
Practice Address - State:WA
Practice Address - Zip Code:98563-3709
Practice Address - Country:US
Practice Address - Phone:360-249-3485
Practice Address - Fax:360-249-2747
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3739152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist