Provider Demographics
NPI:1902970973
Name:WILLIAM SAMUEL ASHLEY, O.D.
Entity Type:Organization
Organization Name:WILLIAM SAMUEL ASHLEY, O.D.
Other - Org Name:THE EYE CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:ASHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:318-574-2369
Mailing Address - Street 1:1010 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:TALLULAH
Mailing Address - State:LA
Mailing Address - Zip Code:71282-5216
Mailing Address - Country:US
Mailing Address - Phone:318-574-2369
Mailing Address - Fax:318-574-1111
Practice Address - Street 1:1010 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:TALLULAH
Practice Address - State:LA
Practice Address - Zip Code:71282-5216
Practice Address - Country:US
Practice Address - Phone:318-574-2369
Practice Address - Fax:318-574-1111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA855-135 T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1317446Medicaid
LAT19414Medicare UPIN
LA47018Medicare ID - Type Unspecified