Active NPI
William M Dickerson Jr., OD
- Optometrist
- Tupelo, MS
National Provider Identifier
1205951241
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 480
- Practice address
- 322 West Main
Tupelo, MS 38802-0497 - Phone
- (662) 842-6634
- Fax
- (662) 842-6626
- NPI assigned
- Mar 20, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 480 | MS | Primary |
Addresses
Primary practice location
322 West Main
Tupelo, MS 38802-0497
Mailing address
322 West Main
PO Box 497
Tupelo, MS 38802-0497
Phone (662) 842-6634
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174348800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1205951241",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "322 WEST MAIN",
"address_2": "PO BOX 497",
"city": "TUPELO",
"state": "MS",
"postal_code": "388020497",
"telephone_number": "662-842-6634",
"fax_number": "662-842-6626"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "322 WEST MAIN",
"city": "TUPELO",
"state": "MS",
"postal_code": "388020497",
"telephone_number": "662-842-6634",
"fax_number": "662-842-6626"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICKERSON",
"first_name": "WILLIAM",
"middle_name": "M",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MS",
"license": "480",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tupelo, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.