Provider Demographics
NPI:1134273923
Name:MIDDLETON, WILLIAM FREDERICK JR (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:FREDERICK
Last Name:MIDDLETON
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:F
Other - Last Name:MIDDLETON, JR. OPTOMETRIST, INC.
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:496 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-3019
Mailing Address - Country:US
Mailing Address - Phone:760-353-1190
Mailing Address - Fax:760-353-2965
Practice Address - Street 1:496 W MAIN ST
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-3019
Practice Address - Country:US
Practice Address - Phone:760-353-1190
Practice Address - Fax:760-353-2965
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5568T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0055680Medicaid
CASD0055680OtherMEDI-CAL PROVIDER NUMBER
CA0861340001Medicare NSC
CAOP5568Medicare PIN