Provider Demographics
NPI:1285779397
Name:WILLIAM A. DOWNEY O.D. INC
Entity type:Organization
Organization Name:WILLIAM A. DOWNEY O.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:ORENE
Authorized Official - Last Name:QUENZER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:530-544-3403
Mailing Address - Street 1:3637 LARCH AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-8448
Mailing Address - Country:US
Mailing Address - Phone:530-544-3403
Mailing Address - Fax:530-544-4032
Practice Address - Street 1:3637 LARCH AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-8448
Practice Address - Country:US
Practice Address - Phone:530-544-3403
Practice Address - Fax:530-544-4032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA0062010152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0062010Medicare UPIN