Basic Information
| Provider Information | |||||||||
| NPI: | 1750357661 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GEDEMER | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4319 MEDICAL DR | ||||||||
| Address2: | 131-102 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109162020 | ||||||||
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| Practice Location | |||||||||
| Address1: | ROGER BROOKS DR | ||||||||
| Address2: | MCHE-QD BAMC-3851 | ||||||||
| City: | FORT SAM HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782346200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109462020 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 5486T | TX | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.