Provider Demographics
NPI:1225034200
Name:EVANS, WILLIAM HERSHEY (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:HERSHEY
Last Name:EVANS
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 1:165 W HASELTINE ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND CENTER
Mailing Address - State:WI
Mailing Address - Zip Code:53581-2552
Mailing Address - Country:US
Mailing Address - Phone:608-647-8995
Mailing Address - Fax:608-647-2569
Practice Address - Street 1:165 W HASELTINE ST
Practice Address - Street 2:
Practice Address - City:RICHLAND CENTER
Practice Address - State:WI
Practice Address - Zip Code:53581-2552
Practice Address - Country:US
Practice Address - Phone:608-647-8995
Practice Address - Fax:608-647-2569
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 6649 TPA152W00000X
WI1664152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38630900Medicaid
WI60700OtherDEAN HEALTH INSURANCE
WI2029369OtherPHYSICIANS PLUS
CASD0066490Medicaid
CASD0066490OtherBLUE SHIELD PROVIDER ID#
CASD0066490Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID#
CASD0066490Medicaid
WI002147805Medicare PIN
WIP00423203Medicare PIN