Provider Demographics
NPI:1154385342
Name:DILLON, WILLIAM H (DO)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:H
Last Name:DILLON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 EVANS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9310
Mailing Address - Country:US
Mailing Address - Phone:239-335-1944
Mailing Address - Fax:239-939-1575
Practice Address - Street 1:1320 N 15TH ST
Practice Address - Street 2:
Practice Address - City:IMMOKALEE
Practice Address - State:FL
Practice Address - Zip Code:34142-2875
Practice Address - Country:US
Practice Address - Phone:239-657-4486
Practice Address - Fax:239-657-4770
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059910207W00000X
FLOS8086207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47903OtherBLUE CROSS BLUE SHIELD
FL4472251OtherCIGNA
FL4370751OtherAETNA
FL235465200Medicaid
FLD38534Medicare UPIN
FL47903OtherBLUE CROSS BLUE SHIELD