Provider Demographics
NPI:1053424424
Name:DOTY, WILLIAM THOMAS (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:THOMAS
Last Name:DOTY
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 1:85 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4929
Mailing Address - Country:US
Mailing Address - Phone:203-438-2840
Mailing Address - Fax:203-431-8396
Practice Address - Street 1:85 MAIN ST
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877
Practice Address - Country:US
Practice Address - Phone:203-438-2840
Practice Address - Fax:203-431-8396
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000867152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT410000387OtherMEDICARE SUBMITTER ID
CT410000387Medicare ID - Type Unspecified
CTT23018Medicare UPIN