Provider Demographics
NPI:1861461766
Name:BILLY, THEODORE JAMES (OD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:JAMES
Last Name:BILLY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1555 BRADY ROAD
Mailing Address - Street 2:
Mailing Address - City:CHESANING
Mailing Address - State:MI
Mailing Address - Zip Code:48616-0355
Mailing Address - Country:US
Mailing Address - Phone:989-845-7050
Mailing Address - Fax:989-845-2036
Practice Address - Street 1:1555 BRADY ROAD
Practice Address - Street 2:
Practice Address - City:CHESANING
Practice Address - State:MI
Practice Address - Zip Code:48616-0355
Practice Address - Country:US
Practice Address - Phone:989-845-7050
Practice Address - Fax:989-845-2036
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003965152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI944316613Medicaid
MIN17900002Medicare ID - Type Unspecified
MI944316613Medicaid
MI0199800001Medicare NSC