William P Fortner, O.D.
Individual provider Active NPI Optometrist · Trenton, TN
NPI 1154416220 · NPPES record last updated Jan 16, 2008
Key facts
- NPI
- 1154416220
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- OD435 (TN)
- Practice address
- 107 E 1St St
Trenton, TN 38382-1841 - Phone
- (731) 855-0811
- Fax
- (731) 855-4725
- NPI assigned
- Oct 4, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OD435 | TN | MD | Optometrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OD435 | TN | Yes |
Addresses
Primary practice location
107 E 1St St
Trenton, TN 38382-1841
Mailing address
PO Box 88
Trenton, TN 38382-0088
Phone (731) 855-0811
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9200 | Other | TN | TLC PIN |
Other providers in Trenton, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 16, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.