Provider Demographics
NPI:1932276292
Name:WILLINGHAM, ALVIN E (OD)
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:E
Last Name:WILLINGHAM
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 1:5211 HIGHWAY 153
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343
Mailing Address - Country:US
Mailing Address - Phone:423-870-3937
Mailing Address - Fax:423-870-8705
Practice Address - Street 1:5211 HIGHWAY 153
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343
Practice Address - Country:US
Practice Address - Phone:423-870-3937
Practice Address - Fax:423-870-8705
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD1107152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T61314Medicare UPIN
TN4943590001Medicare NSC
3596442Medicare PIN