Provider Demographics
NPI:1285621656
Name:FIX, WILLIAM (OD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:FIX
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 1:1200 W DEYOUNG ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-4437
Mailing Address - Country:US
Mailing Address - Phone:618-993-5686
Mailing Address - Fax:618-997-6250
Practice Address - Street 1:321 S PARK AVE
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-3603
Practice Address - Country:US
Practice Address - Phone:618-942-2900
Practice Address - Fax:618-942-4199
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-007446152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0814870007OtherMEDICARE NSC NUMBER
051353OtherHEALTH ALLIANCE
IL046007446Medicaid
IL0814870001OtherMEDICARE NSC NUMBER
IL0814870019OtherMEDICARE NSC NUMBER
IL7446OtherEYEMED
237369OtherHARMONY HEALTH PLAN
IL410039812OtherMEDICARE RAILROAD
IL0814870007OtherMEDICARE NSC NUMBER
IL046007446Medicaid