Provider Demographics
NPI:1316117278
Name:WILLIAM C. WOMBLE
Entity type:Organization
Organization Name:WILLIAM C. WOMBLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:COY
Authorized Official - Last Name:WOMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:931-433-1370
Mailing Address - Street 1:2250 THORNTON TAYLOR PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-3651
Mailing Address - Country:US
Mailing Address - Phone:931-433-1370
Mailing Address - Fax:931-433-1062
Practice Address - Street 1:2250 THORNTON TAYLOR PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-3651
Practice Address - Country:US
Practice Address - Phone:931-433-1370
Practice Address - Fax:931-433-1062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1967332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1310700001Medicare NSC