Provider Demographics
NPI:1063696938
Name:DR. WILLIAM SUTHERLAND LTD
Entity type:Organization
Organization Name:DR. WILLIAM SUTHERLAND LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:COLLEY
Authorized Official - Last Name:SUTHERLAND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:757-229-1131
Mailing Address - Street 1:101 TEWNING RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-2639
Mailing Address - Country:US
Mailing Address - Phone:757-229-1131
Mailing Address - Fax:757-229-1586
Practice Address - Street 1:101 TEWNING RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2639
Practice Address - Country:US
Practice Address - Phone:757-229-1131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000521152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA243847OtherANTHEM BLUE CROSS BLUE SHIELD
VA=========OtherTRICARE
VA=========OtherOPTIMA HEALTH
VA=========OtherTRICARE
VAC03705Medicare PIN