Provider Demographics
NPI:1396740312
Name:WALDRON, WILLIAM JOHN (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOHN
Last Name:WALDRON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2099 GRAND ISLAND BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-2169
Mailing Address - Country:US
Mailing Address - Phone:716-773-7653
Mailing Address - Fax:716-773-3187
Practice Address - Street 1:2099 GRAND ISLAND BLVD
Practice Address - Street 2:STE A
Practice Address - City:GRAND ISLAND
Practice Address - State:NY
Practice Address - Zip Code:14072-2169
Practice Address - Country:US
Practice Address - Phone:716-773-7653
Practice Address - Fax:716-773-3187
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005582-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1978856OtherUNITED HEALTH CARE
NY5884010OtherAETNA
NY00020934002OtherUNIVERA
NY010806583OtherNOVA
NY161578122OtherNORTH AMERICAN PREFERRED
NY410042275OtherMEDICARE RAILROAD
NY146065CSOtherPREFERRED CARE
NY251744484OtherNORTH AMERICAN PREFERRED
NY7290085OtherINDEPENDENT HEALTH
NY9382749OtherPHCS
NY161578122OtherEMPIRE - UNITED HEATLHCAR
NY251744484OtherEMPIRE - UNITED HEALTHCAR
NYNY5582OtherEYEMED
NYP00704467OtherRAILROAD MEDICARE
NY000390107004OtherBLUE CROSS/ BLUE SHIELD
NY5884010OtherAETNA
NY7290085OtherINDEPENDENT HEALTH
NYNY5582OtherEYEMED