Provider Demographics
NPI:1104952910
Name:LOSIE, WILLIAM RAY (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RAY
Last Name:LOSIE
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 1:1680 CHAMBERS ST STE 101
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-3655
Mailing Address - Country:US
Mailing Address - Phone:541-686-1117
Mailing Address - Fax:541-687-2158
Practice Address - Street 1:1680 CHAMBERS ST STE 101
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3655
Practice Address - Country:US
Practice Address - Phone:541-686-1117
Practice Address - Fax:541-687-2158
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1709ATI152W00000X, 152WC0802X, 152WL0500X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR931295758OtherVISION SERVICE PLAN
OR108225Medicaid
ORT76653Medicare UPIN
OR108225Medicaid
OR4187070001Medicare NSC