1902970973 NPI number — WILLIAM SAMUEL ASHLEY, O.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902970973 NPI number — WILLIAM SAMUEL ASHLEY, O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM SAMUEL ASHLEY, O.D.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THE EYE CLINIC
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902970973
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1010 JOHNSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TALLULAH
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71282-5216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-574-2369
Provider Business Mailing Address Fax Number:
318-574-1111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1010 JOHNSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TALLULAH
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71282-5216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-574-2369
Provider Business Practice Location Address Fax Number:
318-574-1111
Provider Enumeration Date:
11/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ASHLEY
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
SAMUEL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
318-574-2369

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  855-135 T , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1317446 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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