Provider Demographics
NPI:1932270097
Name:MANDRICK, WILLIAM (WILLIAM MANDRICK)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:MANDRICK
Suffix:
Gender:M
Credentials:WILLIAM MANDRICK
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:
Other - Last Name:MANDRICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:WILLIAM MANDRICK
Mailing Address - Street 1:6121 MANTON AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-1336
Mailing Address - Country:US
Mailing Address - Phone:818-716-1103
Mailing Address - Fax:
Practice Address - Street 1:17310 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3904
Practice Address - Country:US
Practice Address - Phone:818-728-4260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83686207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology