Basic Information
| Provider Information | |||||||||
| NPI: | 1255447389 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STERLING | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | ENOCH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 407 AVENUE K SE | ||||||||
| Address2: | |||||||||
| City: | WINTER HAVEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338804126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8632943504 | ||||||||
| FaxNumber: | 8632948305 | ||||||||
| Practice Location | |||||||||
| Address1: | 407 AVENUE K SE | ||||||||
| Address2: | |||||||||
| City: | WINTER HAVEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338804126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8632943504 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2006 | ||||||||
| LastUpdateDate: | 06/13/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 0PC001313 | FL | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 078081200 | 05 | FL | MEDICAID | 0PC001313 | 01 | FL | OPTOMETRY LICENSE NUMBER | OTHER |