Provider Demographics
NPI:1831189570
Name:PRICE, WILLIAM ALLAN (OD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ALLAN
Last Name:PRICE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 BRAVO BLVD
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-3478
Mailing Address - Country:US
Mailing Address - Phone:270-651-2181
Mailing Address - Fax:270-651-2183
Practice Address - Street 1:1403 ANDREA ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3335
Practice Address - Country:US
Practice Address - Phone:270-651-2181
Practice Address - Fax:270-651-2183
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1419DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77014199Medicaid
KYU71098Medicare UPIN
KY0515608Medicare ID - Type Unspecified