Provider Demographics
NPI:1215107131
Name:WILLIAM GEORGE OD PA
Entity type:Organization
Organization Name:WILLIAM GEORGE OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:561-681-7801
Mailing Address - Street 1:3674 HAMILTON KY
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-6466
Mailing Address - Country:US
Mailing Address - Phone:561-681-7801
Mailing Address - Fax:
Practice Address - Street 1:11940 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-2832
Practice Address - Country:US
Practice Address - Phone:561-624-0110
Practice Address - Fax:561-691-1594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3586152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU93226Medicare UPIN
FLU93225Medicare UPIN