Provider Demographics
NPI:1215035480
Name:POOL, WILLIAM DAVID (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DAVID
Last Name:POOL
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 1:216 NW 1ST STREET
Mailing Address - Street 2:
Mailing Address - City:GALVA
Mailing Address - State:IL
Mailing Address - Zip Code:61434
Mailing Address - Country:US
Mailing Address - Phone:309-932-3615
Mailing Address - Fax:309-932-2023
Practice Address - Street 1:216 NW 1ST STREET
Practice Address - Street 2:
Practice Address - City:GALVA
Practice Address - State:IL
Practice Address - Zip Code:61434
Practice Address - Country:US
Practice Address - Phone:309-932-3615
Practice Address - Fax:309-932-2023
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046007644152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046007644Medicaid
IL03732024OtherBLUE CROSS BLUE SHIELD
ILDD0570OtherRR MEDICARE
ILP00206090OtherRR MEDICARE
IL5352770001OtherDME
IL03732024OtherBLUE CROSS BLUE SHIELD
T38350Medicare UPIN